Individual
DR. KWANGSUP K SHEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 MAIN ST, PECKVILLE, PA 18452-2009
(570) 383-5511
Mailing address
1400 MAIN ST, PECKVILLE, PA 18452-2009
(570) 383-5511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD056601L
PA
207R00000X
Internal Medicine Physician
MD056601L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001746129
—
PA
01
—
861181
HIGHMARK BLUE SHIELD
PA
Enumeration date
12/20/2005
Last updated
08/05/2008
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