Active NPI
Hyuk Sang Kwon
- Periodontics
- Milwaukee, WI
National Provider Identifier
1255726170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 6001028
- Practice address
- 840 W Juneau Ave Apt 122
Milwaukee, WI 53233-1450 - Phone
- (402) 517-2220
- NPI assigned
- Mar 30, 2015
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 6001028 | WI | Primary |
Addresses
Primary practice location
840 W Juneau Ave Apt 122
Milwaukee, WI 53233-1450
Mailing address
1621 W Wells St
Apt #409
Milwaukee, WI 53233-3204
Phone (414) 377-2371
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- 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 |
|---|---|---|---|---|
| I20160323001854 | KY | Order and Referring Only - Oral Surgery | 4981901675 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001028 | WI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691712000000",
"number": "1255726170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 W WELLS ST",
"address_2": "APT #409",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532333204",
"telephone_number": "414-377-2371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 W JUNEAU AVE APT 122",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532331450",
"telephone_number": "402-517-2220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWON",
"first_name": "HYUK SANG",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-30",
"last_updated": "2023-08-11",
"certification_date": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WI",
"license": "6001028",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.