Provider Demographics
NPI:1407837677
Name:JAKOBSEN, KWAN L (DO)
Entity Type:Individual
Prefix:DR
First Name:KWAN
Middle Name:L
Last Name:JAKOBSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 POST AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2265
Mailing Address - Country:US
Mailing Address - Phone:516-333-3253
Mailing Address - Fax:516-333-8452
Practice Address - Street 1:355 POST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2265
Practice Address - Country:US
Practice Address - Phone:516-333-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197595208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22Z201Medicare ID - Type Unspecified
NJG65047Medicare UPIN