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Organization
KWAK DENTAL MANAGEMENT, PLLC
Active
Organization
KWAK DENTAL MANAGEMENT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEE JOON KWAK (OWNER)
(718) 991-8668
Entity
Organization
Contact information
Practice address
638 EAST 169TH STREET, 2ND FLOOR, BRONX, NY 10456
(718) 991-8668
Mailing address
2321 144TH ST, 2ND FLOOR, WHITESTONE, NY 11357-3433
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
051024-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02872984
—
NY
01
—
180681
DORAL
NY
Enumeration date
03/25/2008
Last updated
03/25/2008
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