Provider Demographics
NPI:1265485379
Name:KUSHNER, JAKE ALDEN (MD)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:ALDEN
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3615 CIVIC CENTER BLVD
Mailing Address - Street 2:CHOP ENDOCRINE, ARC 802C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4318
Mailing Address - Country:US
Mailing Address - Phone:267-426-5717
Mailing Address - Fax:215-590-1605
Practice Address - Street 1:3615 CIVIC CENTER BLVD
Practice Address - Street 2:CHOP ENDOCRINE, ARC 802C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4318
Practice Address - Country:US
Practice Address - Phone:267-426-5717
Practice Address - Fax:215-590-1605
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4230232080P0205X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics