Jiae Kwak, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95018394 Issued in CA

Practice address

1001 S Garfield Ave
Alhambra, CA 91801-4772

Phone

(310) 803-7648

NPI assigned

Sep 17, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Vicky Kwak Professional name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Arroyo Vista Family Health Foundation

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1447353701

  Single Specialty

  Medicare reassignment NPD
• Arroyo Vista Family Health Foundation

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1174665905
  NPD

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1912677253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S GARFIELD AVE",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918014772",
            "telephone_number": "310-803-7648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S GARFIELD AVE",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918014772",
            "telephone_number": "310-803-7648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "JIAE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICKY",
            "last_name": "KWAK",
            "credential": "FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kuo Chiropractic Pain Care Inc.
• Angelica Kuo, D.C.
• Jessica Kuo
• Sok Li Ann Kuo, OTR
• Colleen Nicole Kureghian
• Chris Wai Yin Kwan, D.P.T.
• Scott Kwan, D.P.T.
• Benson Kwee, D.O.
• Long Yin Geoffrey Kwok
• Hau Shan Kwong

• Family Nurse Practitioner in Alhambra, CA
• Providers in Alhambra, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.