Provider Demographics
NPI:1053958249
Name:JSKB HOLDINGS
Entity type:Organization
Organization Name:JSKB HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KWEI
Authorized Official - Middle Name:
Authorized Official - Last Name:TSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-904-2805
Mailing Address - Street 1:1514 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-1105
Mailing Address - Country:US
Mailing Address - Phone:505-588-2819
Mailing Address - Fax:
Practice Address - Street 1:1514 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-1105
Practice Address - Country:US
Practice Address - Phone:505-588-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental