Sofia Kwak

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

37966 Issued in TX

Practice address

2995 Preston Rd Ste 1500
Frisco, TX 75034-0602

Phone

(972) 377-8177

NPI assigned

Apr 11, 2018

Last updated

Apr 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Spa of Texas PC

  • General Practice Dentistry
  • Frisco, TX
  • NPI 1154656171
  NPD (past)

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1316444664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2313 BELLA CT",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 PRESTON RD STE 1500",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750340602",
            "telephone_number": "972-377-8177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2313 Bella Ct",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "TX",
            "postal_code": "750104328",
            "country_code": "US",
            "telephone_number": "201-546-2237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "SOFIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02767500",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "060802",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "37966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Susan Kurien, DO
• Campbell Paige Kutach
• Svetlana Kutikova
• Michael John Kutschke, MD
• Lauren Michelle Kuzniarek, M.S., BCBA
• Jonathan Neal Kwiatkowski, RPH
• Edward Soonjo Kwon, DDS
• Myoungsoo Kwon, D.M.D.
• So Dam Kwon, DDS
• Irene Kwong, PHARM.D.

• General Practice Dentistry in Frisco, TX
• Providers in Frisco, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.