Provider Demographics
NPI:1497281984
Name:KWAG, WON SEOK
Entity Type:Individual
Prefix:
First Name:WON SEOK
Middle Name:
Last Name:KWAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 215TH PL FL 3
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2937
Mailing Address - Country:US
Mailing Address - Phone:516-661-9159
Mailing Address - Fax:
Practice Address - Street 1:4312 215TH PL FL 3
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2937
Practice Address - Country:US
Practice Address - Phone:516-661-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program