Provider Demographics
NPI:1477697050
Name:JENNIFER S. KWAK, M.D.,P.A.
Entity Type:Organization
Organization Name:JENNIFER S. KWAK, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SOOHYUN
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-304-5100
Mailing Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5952
Mailing Address - Country:US
Mailing Address - Phone:281-304-5100
Mailing Address - Fax:281-304-5191
Practice Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5952
Practice Address - Country:US
Practice Address - Phone:281-304-5100
Practice Address - Fax:281-304-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNPI 1427045145OtherNPI FOR PRIVATE PRACTICE
TXNPI 1427045145OtherNPI FOR PRIVATE PRACTICE
TXH86673Medicare UPIN