Healthcare Provider Details

I. General information

NPI: 1073297842
Provider Name (Legal Business Name): CHRISTINA SOONJI KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11332 MOUNTAIN VIEW AVE STE C
LOMA LINDA CA
92354-3854
US

IV. Provider business mailing address

11332 MOUNTAIN VIEW AVE STE C
LOMA LINDA CA
92354-3854
US

V. Phone/Fax

Practice location:
  • Phone: 909-853-9355
  • Fax:
Mailing address:
  • Phone: 909-853-9355
  • Fax: 840-213-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA209459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: