Organization
JACLYN KWAN PA, APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN KWAN PA (OWNER)
(310) 619-1161
Entity
Organization
Contact information
Practice address
6550 PONTO DR SPC 140, CARLSBAD, CA 92011-2317
(310) 619-1161
Mailing address
6550 PONTO DR SPC 140, CARLSBAD, CA 92011-2317
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA51734
PHYSICIAN ASSISTANT BOARD
CA
Enumeration date
11/09/2020
Last updated
11/09/2020
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