Provider Demographics
NPI:1275523748
Name:KWO, JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:KWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST # ST-444
Practice Address - Street 2:ANESTHESIA ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3105
Practice Address - Fax:617-724-8511
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80099207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3171906Medicaid
MAJ18246OtherBCBS MA
MA080099OtherTUFTS HEALTH PLAN
MAA23269Medicare ID - Type Unspecified
MA3171906Medicaid