Healthcare Provider Details

I. General information

NPI: 1841399847
Provider Name (Legal Business Name): STEVE O KWON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ROSE DR
YORBA LINDA CA
92886-2026
US

IV. Provider business mailing address

4300 ROSE DR
YORBA LINDA CA
92886-2026
US

V. Phone/Fax

Practice location:
  • Phone: 714-528-4211
  • Fax: 714-579-6868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: