| K. Kwang Soo, M.d., S.c. | |
|
2691 N Lake Dr Milwaukee WI 53211-3838 | |
| (414) 228-8300 | |
| (414) 228-6303 |
| Full Name | K. Kwang Soo, M.d., S.c. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2691 N Lake Dr, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Kam Kwang Soo (PRESIDENT) |
| Authorized Official Contact | 4149646077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| K. Kwang Soo, M.d., S.c. Po Box 170526 Milwaukee WI 53217-8046 Ph: (414) 228-8300 | K. Kwang Soo, M.d., S.c. 2691 N Lake Dr Milwaukee WI 53211-3838 Ph: (414) 228-8300 |
| NPI Number | 1336296722 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336296722 | NPI | - | NPPES |
| 301 529 00 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 19331 (Wisconsin) | Primary |
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