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NPI Code Detail

MEDICARE: DR. KEVIN D KWAK M.D.

MEDICARE: DR. KEVIN D KWAK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA68495CA

General Provider Information

NPI Number : 1275759425
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN D KWAK M.D.
Provider Business Mailing Address
First Line : PO BOX 3146
Second Line :
City : LA HABRA
State : CA
Zip : 90632-3146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 849 W 34TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90089-0311
Country : US
Telephone Number : 213-821-2501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 07/08/2007

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