Provider Demographics
NPI:1942735063
Name:YEUNG-LAI-WAH, MICHAEL JOHN KWON-QUNE (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN KWON-QUNE
Last Name:YEUNG-LAI-WAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-5426
Mailing Address - Fax:601-984-6889
Practice Address - Street 1:2500 NORTH STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-5426
Practice Address - Fax:601-984-6889
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program