Jae H. Kwak, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

102524 Issued in CA

Practice address

1631 Edinger Ave Ste 105
Tustin, CA 92780-6537

Phone

(714) 717-3757

NPI assigned

Sep 28, 2016

Sex

Female

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

State licenses

Practice roles

Locations

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.

• Jae Hee Kwak DMD Inc

  • Pediatric Dentistry
  • Tustin, CA
  • NPI 1174212740
  NPD Authorized official
• Kim and Watanabe Dental Corporation

  • General Practice Dentistry
  • Murrieta, CA
  • NPI 1336231190
  NPD (past)

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1033668355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24635 MADISON AVE",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629751",
            "telephone_number": "469-449-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 EDINGER AVE STE 105",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806537",
            "telephone_number": "714-717-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "JAE",
        "middle_name": "H.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-28",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "32379",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "102524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nishchal Kumar, M.D.
• Kumkum Patel MD Inc- a Medical Corporation
• Thomas V Kurien, B.PHARM
• Miki Kusaka
• Donald Kuskin, PHYSICAL THERAPIST
• Grace Eun Kwon, D.O.
• Susan Kwon, DMD
• Kyk Medical Professional Corporation
• Laboratory Corporation of America
• Labwest, Inc

• Pediatric Dentistry in Tustin, CA
• Providers in Tustin, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; 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.