Active NPI
Soon Kwak, M.D.
- General Practice Physician
- Los Angeles, CA
National Provider Identifier
1235547662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- A29868
- Practice address
- 806 Teakwood Rd
Los Angeles, CA 90049-1330 - Phone
- (310) 476-8212
- NPI assigned
- Jul 29, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | A29868 | CA | Primary |
Addresses
Primary practice location
806 Teakwood Rd
Los Angeles, CA 90049-1330
Mailing address
122 West St
Unit 4I
Brooklyn, NY 11222-1970
Phone (917) 588-1505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A29868 | CA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406592000000",
"number": "1235547662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 WEST ST",
"address_2": "UNIT 4I",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112221970",
"telephone_number": "917-588-1505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 TEAKWOOD RD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900491330",
"telephone_number": "310-476-8212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "SOON",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-29",
"last_updated": "2014-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "A29868",
"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 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.