Active NPI
Soochung Karen Kwak, D.M.D.
- General Practice Dentistry
- Palisades Park, NJ
National Provider Identifier
1689929341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22DI02505400
- Practice address
- 525 Glen Ave
Palisades Park, NJ 07650-1805 - Phone
- (201) 995-7070
- NPI assigned
- Jul 18, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI02505400 | NJ | Primary |
Addresses
Primary practice location
525 Glen Ave
Palisades Park, NJ 07650-1805
Mailing address
525 Glen Ave
Palisades Park, NJ 07650-1805
Phone (201) 995-7070
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 |
|---|---|---|---|
| 22DI02505400 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342569600000",
"number": "1689929341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 GLEN AVE",
"city": "PALISADES PARK",
"state": "NJ",
"postal_code": "076501805",
"telephone_number": "201-995-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 GLEN AVE",
"city": "PALISADES PARK",
"state": "NJ",
"postal_code": "076501805",
"telephone_number": "201-995-7070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "SOOCHUNG",
"middle_name": "KAREN",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-18",
"last_updated": "2012-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI02505400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palisades Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.