Individual provider Active NPI

Kevin Wooyong Kwak

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1033538632
Registry record updated Oct 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A149375 Issued in CA
Practice address
330 Lewis St Ste 301
San Diego, CA 92103-2108
Phone
(619) 543-6222
NPI assigned
Apr 10, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A149375 CA Primary

Addresses

Primary practice location

330 Lewis St Ste 301
San Diego, CA 92103-2108

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other practice location 1

833 Chestnut St
Suite 220
Philadelphia, PA 19107-4414
Phone (215) 955-8465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170807002444 CA Practitioner - Internal Medicine 9739302647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of New York at Stony Brook, School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, 2,047 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025
  • El Centro Regional Medical Center Hospital, El Centro, CA, CCN 050045

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A149375CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Internal Medicine CurrentSince Jun 12, 2017 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California CurrentSince Jun 12, 2017 Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery PastSince Dec 15, 2019 Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

330 Lewis St
Ste 301
San Diego, CA 92103
Phone (619) 471-9278

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507075200000",
    "number": "1033538632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LEWIS ST STE 301",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032108",
            "telephone_number": "619-543-6222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "833 Chestnut St",
            "address_2": "Suite 220",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074414",
            "country_code": "US",
            "telephone_number": "215-955-8465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "KEVIN",
        "middle_name": "WOOYONG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-10",
        "last_updated": "2017-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A149375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.