Provider Demographics
NPI:1851574313
Name:KWOK, JACQUELINE WEI-MING
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:WEI-MING
Last Name:KWOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10904 SE 176TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5678
Mailing Address - Country:US
Mailing Address - Phone:425-985-4855
Mailing Address - Fax:
Practice Address - Street 1:10904 SE 176TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5678
Practice Address - Country:US
Practice Address - Phone:425-985-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021472390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program