Healthcare Provider Details

I. General information

NPI: 1922400050
Provider Name (Legal Business Name): JAYNE KWON-CLAVADETSCHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E PLAZA BLVD
NATIONAL CITY CA
91950-3523
US

IV. Provider business mailing address

8077 FLORENCE AVE STE 112
DOWNEY CA
90240-3894
US

V. Phone/Fax

Practice location:
  • Phone: 619-434-0299
  • Fax:
Mailing address:
  • Phone: 562-904-6031
  • Fax: 562-905-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-1790
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95004414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: