MEDICARE: JKW MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD60003277	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023348497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKW MEDICAL GROUP

Provider Business Mailing Address
First Line	:	11504 NE 21ST ST
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3025
Country	:	US
Telephone Number	:	425-698-3033
Fax Number	:	425-968-6357

Provider Business Practice Location Address
First Line	:	11504 NE 21ST ST
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3025
Country	:	US
Telephone Number	:	425-698-3033
Fax Number	:	425-968-6357

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JIAKUN WANG
Credential	:	MD
Telephone Number	:	615-423-9545

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	10/04/2022

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Directions to “JKW MEDICAL GROUP ” Practice Location

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