Sang Kwak

Primary specialty

DentistTaxonomy code 122300000X

License

013815 Issued in GA

Practice address

7775 McGinnis Ferry Rd Ste 202
Johns Creek, GA 30024-4963

Phone

(470) 719-0213

NPI assigned

Feb 12, 2009

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 GA

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": "1234396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1194964247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7775 MCGINNIS FERRY RD STE 202",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300244963",
            "telephone_number": "470-719-0213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7775 MCGINNIS FERRY RD STE 202",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300244963",
            "telephone_number": "470-719-0213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "SANG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-12",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "013815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Renee Kopsick, NP
• Deborah Ann Kowalchuk, M.D.
• Mohan K Krishnamachary, MD
• Kelsey Ann Krivis, CNP
• Mythilee Kugathasan, DMD
• So Mee Kwon, FNP
• Soonji Kwon
• Samantha Labolle
• Laboratory Corporation of America Holdings
• Thomas James Lagree, DDS

• Dentist in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.