K. Kwang Soo, M.D., S.C.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

19331 Issued in WI

Legal business name

K. KWANG SOO, M.D., S.C.

Practice address

2691 N Lake Dr
Milwaukee, WI 53211-3838

Phone

(414) 228-8300

Fax

(414) 228-6303

NPI assigned

Jan 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kam Kwang Soo, M.D.NPI 1538245170

Title

President

Phone

(414) 964-6077

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kam Kwan Soo, MD

  • Psychiatry Physician
  • Burlington, WI
  • NPI 1538245170
  NPD (past) Authorized official
• Diane V Digiulio, PH D

  • Clinical Neuropsychologist
  • Juneau, AK
  • NPI 1861430803
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336296722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 170526",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532178046",
            "telephone_number": "414-228-8300",
            "fax_number": "414-228-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2691 N LAKE DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532113838",
            "telephone_number": "414-228-8300",
            "fax_number": "414-228-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K. KWANG SOO, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOO",
        "authorized_official_first_name": "KAM",
        "authorized_official_middle_name": "KWANG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-964-6077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WI",
            "license": "19331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301 529 00",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirstin Elaine Juzenas, LCSW
• Megan Juzwik
• JW'S Helping Hands
• K B K LLC Transport
• K Eye Transit LLC
• K. Paul Katayama, MD SC Dba Advanced Institute of Fertility
• K.T. Adult Day Center LLC
• K&C Home Care LLC
• K&M Advanced Care LLC
• K&M Advanced Care LLC

• Adult Mental Health Clinic/Center in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Adult Mental Health Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.