MEDICARE: YOUNG M KWON MPH, RD, CD

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	133V00000X	Registered Dietitian	DI 60497436	WA

General Provider Information

NPI Number	:	1558762757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG M KWON MPH, RD, CD

Provider Business Mailing Address
First Line	:	2319 N 45TH ST STE 107
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 N 45TH ST STE 107
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6947
Country	:	US
Telephone Number	:	206-512-9109
Fax Number	:

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	07/05/2019

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