Healthcare Provider Details

I. General information

NPI: 1548484926
Provider Name (Legal Business Name): YOON T. KWON M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SIR FRANCIS DRAKE BLVD STE 2
KENTFIELD CA
94904-1419
US

IV. Provider business mailing address

1100 SIR FRANCIS DRAKE BLVD STE 2
KENTFIELD CA
94904-1419
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-4601
  • Fax: 415-459-4607
Mailing address:
  • Phone: 415-459-4601
  • Fax: 415-459-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YOON T KWON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-459-4601