Provider Demographics
NPI:1164893913
Name:KAWK, JONGMUN (DPT)
Entity Type:Individual
Prefix:
First Name:JONGMUN
Middle Name:
Last Name:KAWK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 N HUMBOLDT ST APT 208
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1449
Mailing Address - Country:US
Mailing Address - Phone:415-606-7509
Mailing Address - Fax:
Practice Address - Street 1:847 N HUMBOLDT ST APT 208
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1449
Practice Address - Country:US
Practice Address - Phone:415-606-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist