Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | A139386 | CA |
NPI | 1053739029 |
---|---|
Provider Name | Joseph Kwack |
First Address | Los Angeles, CA 90034-3158 |
Second Address | Santa Monica, CA 90404-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2014 |
Last Update Date | 06/12/2021 |