Provider Demographics
NPI:1497738652
Name:KWAK, KRISTINA L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:KWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2955 MARKET ST STE B1
Mailing Address - Street 2:ALLERGY & ASTHMA ASSOCIATES OF SOUTHWEST VIRGINIA, INC.
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6575
Mailing Address - Country:US
Mailing Address - Phone:540-382-1165
Mailing Address - Fax:540-382-2614
Practice Address - Street 1:2955 MARKET ST STE B1
Practice Address - Street 2:ALLERGY & ASTHMA ASSOCIATES OF SOUTHWEST VIRGINIA, INC.
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6575
Practice Address - Country:US
Practice Address - Phone:540-382-1165
Practice Address - Fax:540-382-2614
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35080337207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09788Medicare UPIN