Individual
CAROL HAEIN KWAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3550 E PHILADELPHIA ST STE 150, ONTARIO, CA 91761-2963
(909) 773-0022
Mailing address
12603 BOUGAINVILLEA WAY, RIVERSIDE, CA 92503-7024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60516
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/21/2020
Last updated
07/06/2022
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