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General NPI Number Information
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NPI Number | 1609811231
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Entity Type | Individual
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Provider Name | SAM TSUNG- MING KWAUK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 185 CANAL ST FRNT 6
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City | NEW YORK
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State | NY
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Zip | 10013-4537
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Country | US
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Telephone | 212-226-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 31 COVERT ST APT 3
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City | BROOKLYN
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State | NY
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Zip | 11207-5522
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Country | US
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Telephone | 347-258-8369
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 164476
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License Number State | NY
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