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General NPI Number Information
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NPI Number | 1609305093
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Entity Type | Individual
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Provider Name | SHARON KWAK PT
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6611 ORANGE STREET #3
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City | LOS ANGELES
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State | CA
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Zip | 90048
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Country | US
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Telephone | 213-447-6154
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 ORANGE ST APT 3
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City | LOS ANGELES
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State | CA
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Zip | 90048-4628
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Country | US
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Telephone | 213-447-6154
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 43189
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License Number State | CA
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