Provider Demographics
NPI:1689929341
Name:KWAK, SOOCHUNG KAREN (DMD)
Entity Type:Individual
Prefix:
First Name:SOOCHUNG
Middle Name:KAREN
Last Name:KWAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1805
Mailing Address - Country:US
Mailing Address - Phone:201-995-7070
Mailing Address - Fax:
Practice Address - Street 1:525 GLEN AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1805
Practice Address - Country:US
Practice Address - Phone:201-995-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025054001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice