Healthcare Provider Details

I. General information

NPI: 1124199039
Provider Name (Legal Business Name): DANIEL JONHUN WON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/21/2022
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

IV. Provider business mailing address

9961 SIERRA AVE MOB #1
FONTANA CA
92335
US

V. Phone/Fax

Practice location:
  • Phone: 407-236-0006
  • Fax: 407-236-0007
Mailing address:
  • Phone: 866-454-3485
  • Fax: 909-427-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG58669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: