Provider Demographics
NPI:1639493521
Name:KWAK, DANIEL JUNG (LAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JUNG
Last Name:KWAK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JUNG
Other - Middle Name:
Other - Last Name:KWAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7506
Mailing Address - Country:US
Mailing Address - Phone:559-545-1512
Mailing Address - Fax:559-570-0185
Practice Address - Street 1:5100 N 6TH ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7506
Practice Address - Country:US
Practice Address - Phone:559-545-1512
Practice Address - Fax:559-570-0185
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-21
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist