Individual
LARRY W. KWAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. , PHD
Contact information
Practice address
1500 DUARTE RD, DUARTE, CA 91010-3012
(626) 256-4673
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
G55439
CA
207RX0202X
Medical Oncology Physician
G55439
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165889001
—
TX
01
—
8M5590
BCBS
TX
01
—
P00170261
RR MEDICARE
TX
Enumeration date
10/04/2006
Last updated
11/11/2020
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