Provider Demographics
NPI:1730115585
Name:KWAK, JINHEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JINHEE
Middle Name:
Last Name:KWAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ARK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3188
Mailing Address - Country:US
Mailing Address - Phone:856-778-8860
Mailing Address - Fax:609-261-4180
Practice Address - Street 1:1295 ROUTE 38 W
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036
Practice Address - Country:US
Practice Address - Phone:609-261-7017
Practice Address - Fax:609-261-4180
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078360002085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0068934Medicaid
NJ090731Medicare PIN
NJ0068934Medicaid