Healthcare Provider Details

I. General information

NPI: 1629981691
Provider Name (Legal Business Name): HYEONJIN KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JOHNS CREEK PKWY STE 180
SUWANEE GA
30024-6090
US

IV. Provider business mailing address

4310 JOHNS CREEK PKWY STE 180
SUWANEE GA
30024-6090
US

V. Phone/Fax

Practice location:
  • Phone: 678-957-8908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN329650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: