Healthcare Provider Details

I. General information

NPI: 1851453732
Provider Name (Legal Business Name): UN-KYUNG LINA KWON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

IV. Provider business mailing address

2014 LEXINGTON DR
FULLERTON CA
92835-3540
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-4026
  • Fax:
Mailing address:
  • Phone: 714-420-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRPH45038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: