Active NPI
Il-Sung Kwak, M.D.
- Anesthesiology Physician
- Fort Wayne, IN
National Provider Identifier
1497788848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 0102632A
- Practice address
- 2222 Timberbrook TRL
Fort Wayne, IN 46845-9530 - Phone
- (260) 637-3939
- NPI assigned
- Jul 9, 2006
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 0102632A | IN | Primary |
Addresses
Primary practice location
2222 Timberbrook TRL
Fort Wayne, IN 46845-9530
Mailing address
2222 Timberbrook TRL
Fort Wayne, IN 46845-9530
Phone (260) 637-3939
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102632A | IN | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497788848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 TIMBERBROOK TRL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468459530",
"telephone_number": "260-637-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 TIMBERBROOK TRL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468459530",
"telephone_number": "260-637-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "IL-SUNG",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IN",
"license": "0102632A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.