Active NPI
Eung-Kwon Pae, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Los Angeles, CA
National Provider Identifier
1043420037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- SP207
- Practice address
- 100 UCLA Medical PLZ Ste 350
Los Angeles, CA 90095-0001 - Phone
- (310) 794-5750
- NPI assigned
- May 22, 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | SP207 | CA | Primary |
Addresses
Primary practice location
100 UCLA Medical PLZ Ste 350
Los Angeles, CA 90095-0001
Mailing address
630 Idaho Ave Apt 201
Santa Monica, CA 90403-2711
Phone (310) 917-2275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151228001851 | MD | Order and Referring Only - Dentist | 8527369032 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP207 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043420037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 IDAHO AVE APT 201",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904032711",
"telephone_number": "310-917-2275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 UCLA MEDICAL PLZ STE 350",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900950001",
"telephone_number": "310-794-5750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAE",
"first_name": "EUNG-KWON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "SP207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.