Provider Demographics
NPI:1306149307
Name:KWOK, JAIME (MS, RD, CDN, CDCES)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:KWOK
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 LAMOKA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3438
Mailing Address - Country:US
Mailing Address - Phone:877-455-3696
Mailing Address - Fax:917-677-6619
Practice Address - Street 1:642 LAMOKA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3438
Practice Address - Country:US
Practice Address - Phone:877-455-3696
Practice Address - Fax:917-677-6619
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NY932208133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty