Healthcare Provider Details

I. General information

NPI: 1871741496
Provider Name (Legal Business Name): GERALD KWON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S OAK KNOLL AVE
PASADENA CA
91101-3418
US

IV. Provider business mailing address

4110 CAMBRIDGE RD
LA CANADA CA
91011-4002
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-2514
  • Fax:
Mailing address:
  • Phone: 310-696-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: