K. KWANG SOO M.D. S.C. NPI 1336296722

NPI Information

NPI: 1336296722
Provider Name: K. KWANG SOO, M.D., S.C.
Classification: Clinic/Center - 261QM0850X
Entity Type: Organization

Specialization: Adult Mental Health

Address:
2691 N LAKE DR
MILWAUKEE, WI
ZIP 53211
Phone: (414) 228-8300
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K. KWANG SOO, M.D., S.C. is an adult mental health clinic center in Milwaukee, WI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. K. KWANG SOO, M.D., S.C. NPI is 1336296722. The provider is registered as an organization entity type.

The provider's business location address is:

2691 N LAKE DR
MILWAUKEE, WI
ZIP 53211-838
Phone: (414) 228-8300
Fax: (414) 228-6303

The provider's authorized official is Kam Kwang Soo .
The authorized official title is President and has the following contact phone number (414) 964-6077.

The enumeration date for this NPI number is 1/5/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	19331	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	301 529 00	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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