Healthcare Provider Details

I. General information

NPI: 1629657531
Provider Name (Legal Business Name): YONG-JEI KWON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST STE 245
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST STE 245
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3331
  • Fax:
Mailing address:
  • Phone: 510-428-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA194803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: