Individual provider Active NPI

Mijeung Gwak, MD

  • Anesthesiology Physician
  • Bronx, NY
National Provider Identifier
1568961035
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
344164 Issued in NY
Practice address
111 E 210TH St
Bronx, NY 10467-2490
Phone
(718) 920-4316
NPI assigned
Feb 9, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 344164 NY Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2490

Mailing address

111 E 210TH St
Bronx, NY 10467-2490
Phone (718) 920-4316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230131003212 MA Practitioner - Anesthesiology 7012388945 Reassigns benefits to 1 organization
I20231206004333 NV Practitioner - Anesthesiology 7012388945 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amin Dunckelmeyer and Luu PLLCGroup PAC ID 4385002682, 48 clinicians
Red Rock Anesthesia Consultants LLCGroup PAC ID 4284910290, 109 clinicians

Practice addresses (Care Compare)

Las Vegas, NV 89117
Phone (469) 983-0099

5400 S Rainbow Blvd
Las Vegas, NV 89118-1859
Phone (702) 325-4651

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14155HIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amin, Dunckelmeyer and Luu PLLC Single Specialty CurrentSince Nov 1, 2023 Accepting new patients
Steward Medical Group, Inc Single Specialty CurrentSince Jan 23, 2023 Accepting new patients
Steward Medical Group, Inc Single Specialty CurrentSince Jan 23, 2023 Accepting new patients
Red Rock Anesthesia Consultants LLC Single Specialty CurrentSince Nov 1, 2023 Accepting new patients

Locations

138 Haverhill St
Andover, MA 01810
Phone (978) 296-2302

2100 Dorchester Ave
Dorchestr Ctr, MA 02124
Phone (617) 506-2222

5400 S Rainbow Blvd
Las Vegas, NV 89118
Phone (702) 252-7342

150 S Nevada Highway 160
Ste 8199
Pahrump, NV 89048
Phone (917) 903-0010

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1568961035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672490",
            "telephone_number": "718-920-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672490",
            "telephone_number": "718-920-4316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWAK",
        "first_name": "MIJEUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "344164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.