Active NPI
Taehee Kwak, MD
- Family Medicine Physician
- Bronx, NY
National Provider Identifier
1295312650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 108647-01
- Practice address
- 3475 Third Ave
Bronx, NY 10456-4811 - Phone
- (929) 468-9401
- NPI assigned
- Mar 24, 2021
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 108647-01 | NY | Primary |
Addresses
Primary practice location
3475 Third Ave
Bronx, NY 10456-4811
Mailing address
3475 3Rd Ave
Bronx, NY 10456-4811
Phone (929) 468-9401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1 | Other | NY | EAST TREMONT MEDICAL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Medgen | Health Information Exchange (HIE) | |
| CONNECT URL | eCW | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 108647-01 | NY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733443200000",
"number": "1295312650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3475 3RD AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104564811",
"telephone_number": "929-468-9401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3475 THIRD AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104564811",
"telephone_number": "929-468-9401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "TAEHEE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-24",
"last_updated": "2024-12-06",
"certification_date": "2024-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "NY",
"license": "108647-01",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EAST TREMONT MEDICAL",
"identifier": "1",
"state": "NY"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Medgen",
"affiliation": "N",
"endpointDescription": "Medgen",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Bronx",
"address_1": "930 E Tremont Ave",
"city": "Bronx",
"state": "NY",
"country_code": "US",
"postal_code": "104604363",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "eCW",
"affiliation": "N",
"endpointDescription": "eCW",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "3475 Third Ave",
"city": "Bronx",
"state": "NY",
"country_code": "US",
"postal_code": "104564811",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.