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Individual

DR. MIN GYU KWAK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS, PHD

Contact information

Practice address
1895 BRENTWOOD RD, BRENTWOOD, NY 11717
(631) 388-7717
(631) 388-7797
Mailing address
21 BARSTOW RD APT 5A, GREAT NECK, NY 11021-2202
(631) 388-7717
(631) 388-7797

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
062915
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
062915
NEW YORK STATE DENTAL LICENSE
NY
Enumeration date
11/28/2022
Last updated
02/12/2026
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