Provider Demographics
NPI:1922400050
Name:KWON-CLAVADETSCHER, JAYNE (APRN)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:KWON-CLAVADETSCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8077 FLORENCE AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3894
Mailing Address - Country:US
Mailing Address - Phone:562-904-6031
Mailing Address - Fax:562-905-6033
Practice Address - Street 1:911 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3523
Practice Address - Country:US
Practice Address - Phone:619-434-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1790363LF0000X
CA95004414363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
13998254OtherCAQH
CA95004414OtherLICENSE
1922400050OtherNPI