Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD423023 | PA |
Y | 2080P0205X | Pediatric Endocrinologist | MD423023 | PA |
NPI | 1265485379 |
---|---|
Provider Name | Dr. Jake Alden Kushner |
First Address | Philadelphia, PA 19104-4318 |
Second Address | Philadelphia, PA 19104-4318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 23/05/2012 |