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General NPI Number Information
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NPI Number | 1487730800
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Entity Type | Individual
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Provider Name | HYUN-SOON ELLEN KWARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 706 GREEN VALLEY RD STE 104
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City | GREENSBORO
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State | NC
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Zip | 27408-7043
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Country | US
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Telephone | 336-387-2500
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Fax | 336-387-2501
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Provider Business Mailing Address
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Address Line | 760 WESTCHESTER AVENUE
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City | RYE BROOK
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State | NY
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Zip | 10573-1320
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Country | US
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Telephone | 914-698-5706
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Fax | 914-698-6624
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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 | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 2010-00097
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 2010-00097
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License Number State | NC
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