Soon Kwark

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38116 Issued in NC

Practice address

11200 Governor Manly Way
Suite 205
Raleigh, NC 27614-8599

Phone

(919) 570-7700

NPI assigned

Dec 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 6, 2016 through Jul 6, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1609939479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PERIMETER PARK DR",
            "address_2": "SUITE 225",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275608421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 GOVERNOR MANLY WAY",
            "address_2": "SUITE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148599",
            "telephone_number": "919-570-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWARK",
        "first_name": "SOON",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "38116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8950491",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Kutch, DNP, FNP-C
• Krista L Kutina, PT
• Lillian M Kutzuba
• Nellie Kwak
• Pil Keun Kwak, LAC
• Michael Diem Kwong, M.D.
• Gabriel A Kyerematen, M.D.
• Kyle J Roth II, DDS, PA
• Kyle J Roth VI DDS PA
• Kyle J. Roth, D.D.S., P.a.

• Family Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.