Active NPI
Sam S Kwon, DMD
- Pediatric Dentistry
- Dacula, GA
National Provider Identifier
1013054402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN012637
- Practice address
- 3635 Braselton Hwy
Suite C
Dacula, GA 30019-1068 - Phone
- (678) 714-7575
- Fax
- (678) 714-7525
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN012637 | GA | Primary |
Addresses
Primary practice location
3635 Braselton Hwy
Suite C
Dacula, GA 30019-1068
Mailing address
4731 Cambridge Trce
Atlanta, GA 30338-5252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012637 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013054402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4731 CAMBRIDGE TRCE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303385252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3635 BRASELTON HWY",
"address_2": "SUITE C",
"city": "DACULA",
"state": "GA",
"postal_code": "300191068",
"telephone_number": "678-714-7575",
"fax_number": "678-714-7525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWON",
"first_name": "SAM",
"middle_name": "S",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DN012637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.