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NPI Code Detail

MEDICARE: HYUN-SOON ELLEN KWARK M.D.

MEDICARE:   HYUN-SOON ELLEN KWARK  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZD0900XDermatopathology (Pathology) Physician2010-00097NC
2207ZP0101XAnatomic Pathology Physician2010-00097NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1184959OTHERNYNY STATE LICENSE

General Provider Information

NPI Number : 1487730800
Entity Type Code : Individual
Provider Name (Legal Business Name) : HYUN-SOON ELLEN KWARK M.D.
Provider Business Mailing Address
First Line : 760 WESTCHESTER AVENUE
Second Line :
City : RYE BROOK
State : NY
Zip : 10573-1320
Country : US
Telephone Number : 914-698-5706
Fax Number : 914-698-6624
Provider Business Practice Location Address
First Line : 706 GREEN VALLEY RD STE 104
Second Line :
City : GREENSBORO
State : NC
Zip : 27408-7043
Country : US
Telephone Number : 336-387-2500
Fax Number : 336-387-2501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 03/31/2025

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Directions to “ HYUN-SOON ELLEN KWARK M.D.” Practice Location

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