Daniel J Kwak, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

6321491-1205 Issued in UT

Practice address

175 N 100 W
Ste 106
Vernal, UT 84078

Phone

(435) 789-9060

Fax

(435) 789-7754

NPI assigned

Nov 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mci8613@yourcarecommunity.org

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306368000000",
    "number": "1023185444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 N 100 W",
            "address_2": "STE 106",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "84078",
            "telephone_number": "435-789-9060",
            "fax_number": "435-789-7754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N 100 W",
            "address_2": "STE 106",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "84078",
            "telephone_number": "435-789-9060",
            "fax_number": "435-789-7754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "DANIEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2011-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "6321491-1205",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "UT",
            "license": "6321491-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Leo Kiedrowski, D.P.T.
• Jody Knight
• Kodiak Counseling
• Lara Kravet, LCSW
• Jerry D. Kulland, P.T.
• Elizabeth Labrum
• Mandaran Labrum
• Amber Marie Lancaster
• Kolby Lance, DMD
• Lasha Marie Lance

• Pediatrics Physician in Vernal, UT
• Providers in Vernal, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; 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.