Provider Demographics
NPI:1578552865
Name:KWAK, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:KWAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2301 EVESHAM ROAD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4507
Mailing Address - Country:US
Mailing Address - Phone:856-520-8718
Mailing Address - Fax:856-520-8719
Practice Address - Street 1:2301 EVESHAM ROAD
Practice Address - Street 2:SUITE 505
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4507
Practice Address - Country:US
Practice Address - Phone:856-520-8718
Practice Address - Fax:856-520-8719
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2017-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB05949300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0040321Medicaid
080842SK3Medicare PIN
NJ0040321Medicaid
I10172Medicare UPIN