Kwak, Min Gyu
Kwak, Min Gyu is an sole proprietor health care provider with primary practice located at 21 Barstow Rd Apt 5A , Great Neck NY 11021-2202. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Kwak, Min Gyu can be contacted via phone (631) 332-6643.Contact Information
Primary practice address
21 Barstow Rd Apt 5A
Great Neck NY 11021-2202
Phone: (631) 332-6643
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X | 062915 | New York |
Profile Details
| NPI number | 1578273082 |
|---|---|
| LBN Legal business name | Kwak, Min Gyu |
| Credentials | DDS, PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 28th, 2022 |
| Last updated | Nov 28th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578273082 | NPPES |
| New York | Other | 062915 | NEW YORK STATE DENTAL LICENSE |
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