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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