Provider Demographics
NPI:1689740193
Name:KWA, SALLY H (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:H
Last Name:KWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:355 W 52ND ST
Mailing Address - Street 2:3RD FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6239
Mailing Address - Country:US
Mailing Address - Phone:646-754-2100
Mailing Address - Fax:646-754-2115
Practice Address - Street 1:355 W 52ND ST
Practice Address - Street 2:3RD FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:646-754-2100
Practice Address - Fax:646-754-2115
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY224451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY224451OtherNY STATE LICENSE
NY224451OtherNY STATE LICENSE
CTBK8410146OtherDEA NUMBER