Provider Demographics
NPI:1386943819
Name:KWAK FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:KWAK FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JIHOON
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-520-8718
Mailing Address - Street 1:139 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5158
Mailing Address - Country:US
Mailing Address - Phone:856-520-8718
Mailing Address - Fax:856-520-8719
Practice Address - Street 1:2301 EVESHAM RD
Practice Address - Street 2:SUITE 505
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4506
Practice Address - Country:US
Practice Address - Phone:856-520-8718
Practice Address - Fax:856-520-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07662200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care