MEDICARE: DR. IK H KWON MD

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	207R00000X	Internal Medicine Physician	MA025605	NJ

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	:	1902821317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IK H KWON MD

Provider Business Mailing Address
First Line	:	1526 NEW DURHAM RD
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-2317
Country	:	US
Telephone Number	:	732-287-2273
Fax Number	:	732-287-4093

Provider Business Practice Location Address
First Line	:	1526 NEW DURHAM RD
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-2317
Country	:	US
Telephone Number	:	732-287-2273
Fax Number	:	732-287-4093

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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