Elbert Kyeung-Ho Kwak, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

25359 Issued in TX

Practice address

1000 Bay Area Blvd
Suite a
Houston, TX 77058-1404

Phone

(281) 990-9400

NPI assigned

May 14, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 and National Provider Directory roles.

• Clear Lake Modern Dentistry, PC

  • General Practice Dentistry
  • Houston, TX
  • NPI 1235415589
  NPD (past)

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

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467417600000",
    "number": "1346568375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BAY AREA BLVD",
            "address_2": "SUITE A",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770581404",
            "telephone_number": "281-990-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BAY AREA BLVD",
            "address_2": "SUITE A",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770581404",
            "telephone_number": "281-990-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "ELBERT",
        "middle_name": "KYEUNG-HO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-14",
        "last_updated": "2016-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25359",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "25359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia K Kuzin, RN CPNP
• Kva Legacy Group LLC
• Elizabeth A Kvale, MD
• Debbie J Kvinge, C.R.N.A.
• KVT Vision L.L.C
• Esther Kwak
• Min Ji Kwak, M.D.
• Samuel Byung-Wook Kwak
• Ekow Kwakye, LPC
• Bridget D Kwami

• Pediatric Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2016; 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.