Individual
MICHAEL DIEM KWONG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3949 BROWNING PL, RALEIGH, NC 27609-6504
(919) 787-8221
(919) 789-4461
Mailing address
PO BOX 19368, RALEIGH, NC 27619-9368
(919) 787-8221
(919) 789-4461
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134RV
BLUECROSS BLUESHIELD
NC
01
—
16-01415
UNITED HEALTHCARE
NC
01
—
16-01419
UNITED HEALTHCARE
NC
01
—
16-01420
UNITED HEALTHCARE
NC
01
—
7977500
AETNA
NC
05
—
89134RV
—
NC
01
—
C8095
MEDCOST
NC
01
—
C9018
MEDCOST
NC
01
—
C9019
MEDCOST
NC
01
—
P00044401
RAILROAD MEDICARE
NC
01
—
P00108512
RAILROAD MEDICARE
NC
01
—
P00263421
RAILROAD MEDICARE
NC
Enumeration date
06/07/2006
Last updated
07/08/2007
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