MEDICARE: LAUREL M KWON ND

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	175F00000X	Naturopath	10-1190	AZ

General Provider Information

NPI Number	:	1770800096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL M KWON ND

Provider Business Mailing Address
First Line	:	5741 AVENIDA ESTORIL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-3231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 AIRWAY AVE STE U3
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4627
Country	:	US
Telephone Number	:	714-754-8008
Fax Number	:

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	02/21/2023

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