Euiyoung Kwak, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015936 Issued in GA

Practice address

4373 Jimmy Lee Smith Pkwy Ste 105
Hiram, GA 30141-2642

Phone

(678) 224-9244

NPI assigned

Aug 1, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18426/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ethne Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Clarkston, GA
  • NPI 1538646054
  Medicare reassignment NPD
• Ethne Health

  • Dental Clinic/Center
  • Clarkston, GA
  • NPI 1073389219
  NPD
• Saini Dental LLC

  • General Practice Dentistry
  • Hiram, GA
  • NPI 1497269922
  NPD (past)

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1003461559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2217 LAKE PARK DR SE APT M",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300808975",
            "telephone_number": "954-604-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4373 JIMMY LEE SMITH PKWY STE 105",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412642",
            "telephone_number": "678-224-9244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "EUIYOUNG",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-01",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kinnerd Diagnostics LLC
• Kinnerd Diagnostics LLC
• Deaisha Kirkland
• Nicole Knight, PT
• Jessica Koalenz, NCC, APC
• Ladybug Lactation LLC.
• Catherine Landers, SPT
• Blake Anthony Landry, PA-C
• Erin Landry, PAC
• Christopher Laurenzi, D.C.

• General Practice Dentistry in Hiram, GA
• Providers in Hiram, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.