Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N005468 | NY |
N | 213ES0103X | Foot & Ankle Surgery | 25MD002511 | NJ |
NPI | 1629129887 |
---|---|
Provider Name | Dr. Jake S Kwon |
First Address | Flushing, NY 11354-6508 |
Second Address | Flushing, NY 11354-6508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 31/10/2008 |