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NPI Code Detail

MEDICARE: DR. GINA SUE KWAK M.D.

MEDICARE: DR. GINA SUE 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
1207RG0100XGastroenterology Physician187525NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14V2271OTHERNYBC/BS

General Provider Information

NPI Number : 1396742201
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GINA SUE KWAK M.D.
Provider Business Mailing Address
First Line : 310 E SHORE RD
Second Line : 206
City : GREAT NECK
State : NY
Zip : 11023-2432
Country : US
Telephone Number : 516-487-7677
Fax Number : 516-487-2868
Provider Business Practice Location Address
First Line : 310 E SHORE RD
Second Line : 206
City : GREAT NECK
State : NY
Zip : 11023-2432
Country : US
Telephone Number : 516-487-7677
Fax Number : 516-487-2868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 12/16/2009

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