Jenise Kwak, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

35014 Issued in TX

Practice address

2800 S Interstate 35 Ste 500
Austin, TX 78681-8098

Phone

(512) 726-0440

NPI assigned

Jun 30, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

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

{
    "created_epoch": "1498780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1417478223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 S INTERSTATE 35 STE 500",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "786818098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 S INTERSTATE 35 STE 500",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "786818098",
            "telephone_number": "512-726-0440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3043 Main St # A",
            "address_purpose": "LOCATION",
            "city": "Glastonbury",
            "state": "CT",
            "postal_code": "060331029",
            "country_code": "US",
            "telephone_number": "860-430-4106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "434 N Main St",
            "address_purpose": "LOCATION",
            "city": "East Longmeadow",
            "state": "MA",
            "postal_code": "010281850",
            "country_code": "US",
            "telephone_number": "413-273-8179",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "JENISE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-30",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "35014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin M Kux, MA, CCC-SLP
• Kieran Kelly Kuykendall I, DC
• Sabina Kuzmina
• Miriam Kuznets, LCSW
• KVT Psychotherapy PLLC
• Bernice Wah Kwan, RD
• Judith Kwarteng Amaning, MD
• Kwik Psych Clinics PLLC
• Alyssa Kwok, M.D.
• April Kwon, APRN-CNP

• General Practice Dentistry in Austin, TX
• Providers in Austin, 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 Jun 28, 2022; 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.