Provider Demographics
NPI:1316030042
Name:KWAK, SYNG YONG (MD)
Entity Type:Individual
Prefix:
First Name:SYNG
Middle Name:YONG
Last Name:KWAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3916
Mailing Address - Country:US
Mailing Address - Phone:718-273-8052
Mailing Address - Fax:718-370-3736
Practice Address - Street 1:2144 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3916
Practice Address - Country:US
Practice Address - Phone:718-273-8052
Practice Address - Fax:718-370-3736
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1368472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B13903Medicare UPIN