Healthcare Provider Details

I. General information

NPI: 1922443464
Provider Name (Legal Business Name): YOUNG J. KWAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 PALO VERDE AVE STE 102
LONG BEACH CA
90815-1561
US

IV. Provider business mailing address

2921 PALO VERDE AVE STE 102
LONG BEACH CA
90815-1561
US

V. Phone/Fax

Practice location:
  • Phone: 562-999-3483
  • Fax: 562-262-2215
Mailing address:
  • Phone: 562-999-3483
  • Fax: 562-262-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA165830
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA165830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: