MEDICARE: DR. JAKE S KWON D.P.M.

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	213EP1101X	Primary Podiatric Medicine Podiatrist	N005468	NY
2	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD002511	NJ

General Provider Information

NPI Number	:	1629129887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAKE S KWON D.P.M.

Provider Business Mailing Address
First Line	:	81 PILGRIM LN
Second Line	:
City	:	WESTBURY
State	:	NY
Zip	:	11590-6218
Country	:	US
Telephone Number	:	646-389-6485
Fax Number	:	718-939-9865

Provider Business Practice Location Address
First Line	:	4232 FRANCIS LEWIS BLVD # C
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2561
Country	:	US
Telephone Number	:	646-389-6485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	03/05/2026

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