Healthcare Provider Details

I. General information

NPI: 1114912201
Provider Name (Legal Business Name): Y. JOE KWON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18092 WIKA RD
APPLE VALLEY CA
92307-2132
US

IV. Provider business mailing address

18092 WIKA RD
APPLE VALLEY CA
92307-2132
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-1230
  • Fax: 760-946-1255
Mailing address:
  • Phone: 760-946-1230
  • Fax: 760-946-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. YOUNG JOE KWON
Title or Position: OWNER
Credential: MD, FACR
Phone: 760-946-1230