Active NPI
Michael Kwon
- Pharmacist
- Janesville, WI
National Provider Identifier
1477180495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19972-40
- Practice address
- 1700 Milton Ave
Janesville, WI 53545-0833 - Phone
- (608) 756-0614
- NPI assigned
- Mar 27, 2020
- Last updated
- Mar 27, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19972-40 | WI | Primary |
Addresses
Primary practice location
1700 Milton Ave
Janesville, WI 53545-0833
Mailing address
1700 Milton Ave
Janesville, WI 53545-0833
Phone (608) 756-0614
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19972-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585267200000",
"number": "1477180495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 MILTON AVE",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535450833",
"telephone_number": "608-756-0614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 MILTON AVE",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535450833",
"telephone_number": "608-756-0614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWON",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-27",
"last_updated": "2020-03-27",
"certification_date": "2020-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "19972-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Janesville, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.