Provider Demographics
NPI:1730285750
Name:KWAK, SANG CHOL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:CHOL
Last Name:KWAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N BERKELEY LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1744
Mailing Address - Country:US
Mailing Address - Phone:770-220-0088
Mailing Address - Fax:770-220-0299
Practice Address - Street 1:2700 N BERKELEY LAKE RD NW STE 110
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1744
Practice Address - Country:US
Practice Address - Phone:770-220-0088
Practice Address - Fax:770-220-0299
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics