Active NPI
Jessica Kwak
- Pharmacist
- Cambridge, MA
National Provider Identifier
1972264455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH240612
- Practice address
- 36 White Street
Cambridge, MA 02140 - Phone
- (617) 876-5519
- NPI assigned
- Jan 6, 2022
- 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 | PH240612 | MA | Primary |
Addresses
Primary practice location
36 White Street
Cambridge, MA 02140
Mailing address
36 White Street
Cambridge, MA 02140
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 |
|---|---|---|---|
| PH240612 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641427200000",
"number": "1972264455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 WHITE STREET",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "02140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 WHITE STREET",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "02140",
"telephone_number": "617-876-5519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-06",
"last_updated": "2022-01-06",
"certification_date": "2022-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH240612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.