Carol Haein Kwak, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

60516 Issued in CA

Practice address

3550 E Philadelphia St Ste 150
Ontario, CA 91761-2963

Phone

(909) 773-0022

NPI assigned

Jul 21, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oneil Enterprises IncGroup PAC ID 9638506686, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: carol.kwak.1@7542.direct.athenahealth.com

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.

• Oneil Enterprises Inc

  • Urgent Care Clinic/Center
  • Lakewood, CA
  • NPI 1184186629
  Medicare reassignment Care Compare group
• Wu & Diaz Professional Corp

  • Family Medicine Physician
  • Ontario, CA
  • NPI 1548356884
  NPD (past)

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1891303293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12603 BOUGAINVILLEA WAY",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925037024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 E PHILADELPHIA ST STE 150",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917612963",
            "telephone_number": "909-773-0022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10900 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441067506",
            "country_code": "US",
            "telephone_number": "216-368-0575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "CAROL",
        "middle_name": "HAEIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Kubacki
• Darian Kuhn
• Alan Kuo, M.D.
• Hsiang Chun Kuo, L.AC.
• Joanne Kuo, PHARMD
• Montaye Kyle
• Shannon La Bounty
• Jennifer Tablac Lacanlale, PT
• Alcira Lacayo
• Isabella Lafarre

• Physician Assistant in Ontario, CA
• Providers in Ontario, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; 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.