Healthcare Provider Details

I. General information

NPI: 1487730800
Provider Name (Legal Business Name): HYUN-SOON ELLEN KWARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 GREEN VALLEY RD STE 104
GREENSBORO NC
27408-7043
US

IV. Provider business mailing address

760 WESTCHESTER AVENUE
RYE BROOK NY
10573-1320
US

V. Phone/Fax

Practice location:
  • Phone: 336-387-2500
  • Fax: 336-387-2501
Mailing address:
  • Phone: 914-698-5706
  • Fax: 914-698-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2010-00097
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2010-00097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: