MEDICARE: DR. YOUNG JAE KWON M.D.

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	208000000X	Pediatrics Physician	A37514	CA
2	208D00000X	General Practice Physician	A37514	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225191505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUNG JAE KWON M.D.

Provider Business Mailing Address
First Line	:	1040 ELM AVE STE 301
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3267
Country	:	US
Telephone Number	:	562-435-4777
Fax Number	:	562-435-3947

Provider Business Practice Location Address
First Line	:	1040 ELM AVE STE 301
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3267
Country	:	US
Telephone Number	:	562-435-4777
Fax Number	:	562-435-3947

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	05/05/2026

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