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NPI Code Detail

MEDICARE: JEFFREY DEXTER KWOK P.T.

MEDICARE: JEFFREY DEXTER KWOK P.T.
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
1225100000XPhysical TherapistPT 39121CA

General Provider Information

NPI Number : 1588910103
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY DEXTER KWOK P.T.
Provider Business Mailing Address
First Line : 1808 S BUNDY DR
Second Line : APT 7
City : LOS ANGELES
State : CA
Zip : 90025-5225
Country : US
Telephone Number : 408-390-0008
Fax Number :
Provider Business Practice Location Address
First Line : 8250 WOODMAN AVE
Second Line : NORTH 2 BUILDING
City : PANORAMA CITY
State : CA
Zip : 91402-5427
Country : US
Telephone Number : 818-375-2033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2012
Last Update Date : 12/01/2021

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