Active NPI
Sungeun Kwak
- Pharmacist
- Camillus, NY
National Provider Identifier
1942522271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 054053
- Practice address
- 5206 W Genesee St
Camillus, NY 13031-2202 - Phone
- (315) 468-1701
- NPI assigned
- Mar 1, 2010
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 054053 | NY | Primary |
Addresses
Primary practice location
5206 W Genesee St
Camillus, NY 13031-2202
Mailing address
8391 Glen Eagle Dr
Manlius, NY 13104-9799
Phone (315) 682-7998
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02822851 | Medicaid | NY |
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 |
|---|---|---|---|
| 054053 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pharmacy
- Camillus, NY
- NPI 1831124841
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267401600000",
"number": "1942522271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8391 GLEN EAGLE DR",
"city": "MANLIUS",
"state": "NY",
"postal_code": "131049799",
"telephone_number": "315-682-7998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5206 W GENESEE ST",
"city": "CAMILLUS",
"state": "NY",
"postal_code": "130312202",
"telephone_number": "315-468-1701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "SUNGEUN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-01",
"last_updated": "2010-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "054053",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02822851",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camillus, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.