Provider Demographics
NPI:1780892224
Name:KWAK, JASON YEU
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:YEU
Last Name:KWAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 LANCASTER DRIVE
Mailing Address - Street 2:APARTMENT H14
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:215-872-0697
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-825-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program