Healthcare Provider Details

I. General information

NPI: 1588963243
Provider Name (Legal Business Name): ROBERT T. KWAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 LOS GATOS BLVD
LOS GATOS CA
95032-2502
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 408-730-6222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA127352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: