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General NPI Number Information
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NPI Number | 1023348497
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Entity Type | Organization
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Legal Business Name | JKW MEDICAL GROUP
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 11504 NE 21ST ST
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City | BELLEVUE
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State | WA
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Zip | 98004-3025
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Country | US
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Telephone | 425-698-3033
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Fax | 425-968-6357
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Provider Business Mailing Address
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Address Line | 11504 NE 21ST ST
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City | BELLEVUE
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State | WA
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Zip | 98004-3025
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Country | US
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Telephone | 425-698-3033
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Fax | 425-968-6357
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIAKUN WANG
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Credential | MD
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Telephone | 615-423-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD60003277
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License Number State | WA
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