Healthcare Provider Details

I. General information

NPI: 1932046299
Provider Name (Legal Business Name): JASON INTAEK KWON CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD STE 530
ATLANTA GA
30342-5005
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD STE 530
ATLANTA GA
30342-5005
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-1415
  • Fax:
Mailing address:
  • Phone: 404-257-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: