Provider Demographics
NPI:1780083204
Name:KWONG, JASON D (PHARM D)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:KWONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1334
Mailing Address - Country:US
Mailing Address - Phone:408-556-4507
Mailing Address - Fax:408-556-4508
Practice Address - Street 1:4080 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1334
Practice Address - Country:US
Practice Address - Phone:408-556-4507
Practice Address - Fax:408-556-4508
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist