Jin Sang Kwon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

53616 Issued in CA

Practice address

2045 W Briggsmore Ave
Suite E
Modesto, CA 95350-3767

Phone

(209) 527-3000

NPI assigned

Dec 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053473736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 EMPRESS LN",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953828707",
            "telephone_number": "209-485-6638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 W BRIGGSMORE AVE",
            "address_2": "SUITE E",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503767",
            "telephone_number": "209-527-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "JIN SANG",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Marie Kurtz, PHARM.D.
• Brian Kurtz, MD
• Durga Kurupath
• Kwang Min Lim DMD a Professional Corporation
• Grace Y Kwon-Hong
• Daniel Kwong, DMD
• Evelyn Kwong, PHARMD
• Sara J Kwong, MD
• Kyle Heron MD PC
• Becca Kysar

• General Practice Dentistry in Modesto, CA
• Providers in Modesto, CA by specialty
• General Practice Dentistry in California

• 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.

Verify at the official NPI Registry.