Provider Demographics
NPI:1689808024
Name:KWAK, CHARLES CHANG (PH D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHANG
Last Name:KWAK
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3481
Mailing Address - Country:US
Mailing Address - Phone:212-219-7772
Mailing Address - Fax:212-219-9595
Practice Address - Street 1:78 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3481
Practice Address - Country:US
Practice Address - Phone:212-219-7772
Practice Address - Fax:212-219-9595
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports