Provider Demographics
NPI:1699837930
Name:KWAK, KYONG KEUN (ACCUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:KYONG
Middle Name:KEUN
Last Name:KWAK
Suffix:
Gender:M
Credentials:ACCUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10063 FOLSOM BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1434
Mailing Address - Country:US
Mailing Address - Phone:916-361-7870
Mailing Address - Fax:916-361-7870
Practice Address - Street 1:10063 FOLSOM BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1434
Practice Address - Country:US
Practice Address - Phone:916-361-7870
Practice Address - Fax:916-361-7870
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist