Healthcare Provider Details

I. General information

NPI: 1619255411
Provider Name (Legal Business Name): JASON KWAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DEVINE ST
NORTH HAVEN CT
06473-2195
US

IV. Provider business mailing address

333 CEDAR ST PO BOX 208013
NEW HAVEN CT
06520-8013
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number63977
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63977
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: