Basic Information
| Provider Information | |||||||||
| NPI: | 1386050151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWONG | ||||||||
| FirstName: | LUCIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7510 NE 193RD CT | ||||||||
| Address2: | |||||||||
| City: | KENMORE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980283309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038814168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1019 112TH ST SW | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982044875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255516200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2014 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 60955882 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.