Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 236600 | NY |
NPI | 1568514412 |
---|---|
Provider Name | Dr. Edward S. Kwak |
First Address | New York, NY 10021-4264 |
Second Address | New York, NY 10021-4264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 09/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02877961 | (05) | NY |