Jae-Hyuck Kwak, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

23724 Issued in TX

Practice address

104 Professional Park Dr
Victoria, TX 77904-2351

Phone

(361) 573-3841

Fax

(361) 573-1930

NPI assigned

Mar 16, 2008

Last updated

May 1, 2020By the provider in NPPES

Sex

Male

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 TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Swinford C Wilson DDS Inc

  • General Practice Dentistry
  • Victoria, TX
  • NPI 1871634329
  NPD (past)

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

{
    "created_epoch": "1205625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588291200000",
    "number": "1982875118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 PROFESSIONAL PARK DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042351",
            "telephone_number": "361-573-3841",
            "fax_number": "361-573-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 PROFESSIONAL PARK DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042351",
            "telephone_number": "361-573-3841",
            "fax_number": "361-573-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "JAE-HYUCK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-16",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23724",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trisha L Kucera
• William Terry Kuester, M.A.,LPC
• Haresh Kumar, M.D
• Alayna Kutach, FNP-C
• Blanca Kuzet, SLP
• Laboratory Corporation of America
• Chelsea Laging
• Sundeep S Lal, MD
• Peter Lam, MD
• Kevin Dale Lange, PT

• General Practice Dentistry in Victoria, TX
• Providers in Victoria, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; 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.