NPIMap

Organization Active NPI

Charles C. Kwak, MD, PLLC

  • Dermatology Physician
  • Flushing, NY
National Provider Identifier
1699045229
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
218069 Issued in NY
Legal business name
CHARLES C. KWAK, MD, PLLC
Practice address
3420 Parsons Blvd
LF
Flushing, NY 11354-4622
Phone
(718) 460-1639
NPI assigned
Jan 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

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

Authorized official

Name
Dr. Charles C Kwak, M.D.
Title
Proprietor
Phone
(718) 460-1639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 218069 NY Primary

Addresses

Primary practice location

3420 Parsons Blvd
LF
Flushing, NY 11354-4622

Mailing address

3420 Parsons Blvd
LF
Flushing, NY 11354-4622

National Provider Directory

National Provider Directory

Locations

3420 Parsons Blvd
Apt Lf
Flushing, NY 11354
Phone (718) 460-1639

NPI Registry JSON

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326326400000",
    "number": "1699045229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 PARSONS BLVD",
            "address_2": "LF",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113544622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 PARSONS BLVD",
            "address_2": "LF",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113544622",
            "telephone_number": "718-460-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES C. KWAK, MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-12",
        "last_updated": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "KWAK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "718-460-1639",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "218069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.

Verify at the official NPI Registry.