Provider Demographics
NPI:1316011364
Name:KWAK, SANDRA SOOHYUN (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SOOHYUN
Last Name:KWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28884
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2040
Mailing Address - Country:US
Mailing Address - Phone:949-645-8800
Mailing Address - Fax:949-645-8844
Practice Address - Street 1:520 SUPERIOR AVE STE 310
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3667
Practice Address - Country:US
Practice Address - Phone:949-645-8800
Practice Address - Fax:949-645-8844
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88895207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism