Individual provider Active NPI

Christina Gwak, L.AC., O.M.D., PH.D.

  • Acupuncturist
  • Redlands, CA
National Provider Identifier
1013326966
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC 4264 Issued in CA
Practice address
1752 E Lugonia Ave
Ste #110
Redlands, CA 92374-2730
Phone
(909) 794-1112
Fax
(909) 794-1115
NPI assigned
Aug 5, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC 4264 CA Primary

Addresses

Primary practice location

1752 E Lugonia Ave
Ste #110
Redlands, CA 92374-2730

Mailing address

1752 E Lugonia Ave
Ste #110
Redlands, CA 92374-2730

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
AC 4264CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Iris Acupuncture and Herbal Clinic Acupuncturist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1013326966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1752 E LUGONIA AVE",
            "address_2": "STE #110",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1752 E LUGONIA AVE",
            "address_2": "STE #110",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742730",
            "telephone_number": "909-794-1112",
            "fax_number": "909-794-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWAK",
        "first_name": "CHRISTINA",
        "name_prefix": "Dr.",
        "credential": "L.AC., O.M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-05",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC 4264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; 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.