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General NPI Number Information
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NPI Number | 1699045229
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Entity Type | Organization
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Legal Business Name | CHARLES C. KWAK, MD, PLLC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 3420 PARSONS BLVD LF
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City | FLUSHING
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State | NY
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Zip | 11354-4622
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Country | US
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Telephone | 718-460-1639
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 PARSONS BLVD LF
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City | FLUSHING
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State | NY
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Zip | 11354-4622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. CHARLES C KWAK
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Credential | M.D.
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Telephone | 718-460-1639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 218069
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License Number State | NY
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