Healthcare Provider Details

I. General information

NPI: 1972097855
Provider Name (Legal Business Name): JAKRIN KEWCHAROEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE STE 501
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

1356 LUSITANA ST STE 510
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2873
  • Fax:
Mailing address:
  • Phone: 808-586-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA173806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: