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General NPI Number Information
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NPI Number | 1366071037
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Entity Type | Individual
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Provider Name | HAKYONG GLORIA KWAK MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 825 RIDGE LAKE BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-9411
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Country | US
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Telephone | 901-685-2200
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Fax | 901-255-5631
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Provider Business Mailing Address
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Address Line | PO BOX 22510
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City | JACKSON
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State | MS
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Zip | 39225-2510
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Country | US
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Telephone | 901-685-2200
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Fax | 901-255-5631
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 74667
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License Number State | TN
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