Healthcare Provider Details

I. General information

NPI: 1124555842
Provider Name (Legal Business Name): SUNGJIN KUON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 SANTA MONICA BLVD STE 301
SANTA MONICA CA
90404-2067
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90095-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-998-9118
  • Fax: 310-829-9318
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A18221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: