Healthcare Provider Details

I. General information

NPI: 1831595289
Provider Name (Legal Business Name): JASON KWOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 SW 20TH ST
PENDLETON OR
97801-1804
US

IV. Provider business mailing address

7701 W 4TH AVE APT K204
KENNEWICK WA
99336-8535
US

V. Phone/Fax

Practice location:
  • Phone: 917-749-3596
  • Fax:
Mailing address:
  • Phone: 917-749-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014615
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60469795
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: