Healthcare Provider Details

I. General information

NPI: 1841679800
Provider Name (Legal Business Name): SOONNAM KWON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2015
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 SONOMA VISTA DR
SONOMA CA
95476-4057
US

IV. Provider business mailing address

761 SONOMA VISTA DR
SONOMA CA
95476-4057
US

V. Phone/Fax

Practice location:
  • Phone: 707-509-5040
  • Fax:
Mailing address:
  • Phone: 707-430-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number517096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: