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General NPI Number Information
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NPI Number | 1104766526
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Entity Type | Individual
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Provider Name | NAYOUNG KWAK
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Gender | Female
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 184 BARTON ST
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City | BUFFALO
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State | NY
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Zip | 14213-1573
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Country | US
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Telephone | 716-881-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 916 DELAWARE AVE APT 5C
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City | BUFFALO
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State | NY
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Zip | 14209-1851
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Country | US
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Telephone | 405-615-5597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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