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General NPI Number Information
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NPI Number | 1235547662
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Entity Type | Individual
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Provider Name | SOON KWAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 806 TEAKWOOD RD
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City | LOS ANGELES
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State | CA
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Zip | 90049-1330
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Country | US
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Telephone | 310-476-8212
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Fax |
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Provider Business Mailing Address
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Address Line | 122 WEST ST UNIT 4I
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City | BROOKLYN
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State | NY
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Zip | 11222-1970
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Country | US
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Telephone | 917-588-1505
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A29868
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License Number State | CA
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