Healthcare Provider Details

I. General information

NPI: 1053958249
Provider Name (Legal Business Name): JSKB HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 COORS BLVD NW
ALBUQUERQUE NM
87121-1105
US

IV. Provider business mailing address

1514 COORS BLVD NW
ALBUQUERQUE NM
87121-1105
US

V. Phone/Fax

Practice location:
  • Phone: 505-588-2819
  • Fax:
Mailing address:
  • Phone: 505-588-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KWEI TSCHEN
Title or Position: PARTNER
Credential:
Phone: 216-904-2805