Organization
K. KWANG SOO, M.D., S.C.
Active
Organization
K. KWANG SOO, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAM KWANG SOO M.D. (PRESIDENT)
(414) 964-6077
Entity
Organization
Contact information
Practice address
2691 N LAKE DR, MILWAUKEE, WI 53211-3838
(414) 228-8300
(414) 228-6303
Mailing address
PO BOX 170526, MILWAUKEE, WI 53217-8046
(414) 228-8300
(414) 228-6303
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
19331
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301 529 00
—
WI
Enumeration date
01/05/2007
Last updated
08/22/2020
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