Charles C Kwak, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

218069 Issued in NY

Practice address

4012 80TH St
Elmhurst, NY 11373-1234

Phone

(718) 886-9000

NPI assigned

Aug 8, 2006

Last updated

Aug 31, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

State University of Ny Upstate Medical University, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Healthcare IncGroup PAC ID 1254233158, 58 clinicians

Metro Dermatology of Ny,P.C.Group PAC ID 3779761705, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Sinai Hospital Hospital, New York, NY, CCN 330024

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: cck@metrodermatology.emadirect.md
• Direct secure messaging: charles.kwak.p1@direct.premierhealthcare.nextgenshare.com

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.

• Metro Dermatology of Ny,PC

  • Physician Assistant
  • Flushing, NY
  • NPI 1336343268

  Dermatology

  Medicare reassignment Care Compare group NPD
• Premier Healthcare, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
  • NPI 1760436190
  Medicare reassignment Care Compare group
• Young Adult Institute, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
  • NPI 1144314576
  NPD
• Metro Dermatology of NJ,PA

  • Procedural Dermatology Physician
  • Fort Lee, NJ
  • NPI 1437353372
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mount Sinai Hospital

  • Clinical Medical Laboratory
  • New York, NY
  • NPI 1033206362

  Hospital

  Care Compare affiliation
• Mount Sinai Hospital

  • General Acute Care Hospital
  • Long Island City, NY
  • NPI 1245248939
  Care Compare affiliation
• Mount Sinai Hospital

  • Rehabilitation Hospital
  • New York, NY
  • NPI 1669440327
  Care Compare affiliation
• Mount Sinai Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1932103413
  Care Compare affiliation
• Mount Sinai Hospital Pharmacy

  • General Acute Care Hospital
  • New York, NY
  • NPI 1225295512
  Care Compare affiliation
• Mount Sinai Hospital-Ambulance

  • Ambulance
  • New York, NY
  • NPI 1568601342

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1548270218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 80TH ST",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731234",
            "telephone_number": "718-886-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4012 80TH ST",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731234",
            "telephone_number": "718-886-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Centerock Rd",
            "address_purpose": "LOCATION",
            "city": "West Nyack",
            "state": "NY",
            "postal_code": "109942215",
            "country_code": "US",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "CHARLES",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "218069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charles.kwakmd.p1@direct.crystalrun.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2 Centerock Rd",
            "city": "West Nyack",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109942215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cck@metrodermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "4012 80th St",
            "city": "Elmhurst",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113731234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kae Kuratomo
• Monika Anna Kurdziel, RDN, CDCES
• Lysamma Kuruvila, PHARMACYTECH
• Igor Kusayev
• Ranjna Kutwal-Sharma, RPH
• Harry Kwak
• Hye-Won Kwon, L.C.S.W
• Florence Kwong, LMSW
• Yuyu Kyaw, PHARM D
• Shion Kydd

• Dermatology Physician in Elmhurst, NY
• Providers in Elmhurst, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.