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NPI Code Detail

MEDICARE: CHRISTINE HAEYOON KWON DMD

MEDICARE: CHRISTINE HAEYOON KWON DMD
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
11223G0001XGeneral Practice DentistryDEN4728ME

General Provider Information

NPI Number : 1659931566
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE HAEYOON KWON DMD
Provider Business Mailing Address
First Line : 85 WESTERN AVE
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 85 WESTERN AVE
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2423
Country : US
Telephone Number : 207-408-0479
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/13/2019

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