Provider Demographics
NPI:1255626875
Name:KWAK, HOSEOK
Entity type:Individual
Prefix:
First Name:HOSEOK
Middle Name:
Last Name:KWAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 STRAUSS TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7148
Mailing Address - Country:US
Mailing Address - Phone:240-461-4777
Mailing Address - Fax:
Practice Address - Street 1:15015 41ST AVE STE 3E
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4929
Practice Address - Country:US
Practice Address - Phone:718-886-0055
Practice Address - Fax:718-321-8524
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70 012029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor