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General NPI Number Information
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NPI Number | 1730115585
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Entity Type | Individual
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Provider Name | JINHEE KWAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 1295 ROUTE 38 W
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City | HAINESPORT
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State | NJ
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Zip | 08036
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Country | US
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Telephone | 609-261-7017
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Fax | 609-261-4180
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Provider Business Mailing Address
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Address Line | 210 ARK RD
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-3188
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Country | US
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Telephone | 856-778-8860
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Fax | 609-261-4180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25MA07836000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA07836000
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License Number State | NJ
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