Healthcare Provider Details

I. General information

NPI: 1720046386
Provider Name (Legal Business Name): JOHN H. KWON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 GAUSE BLVD E
SLIDELL LA
70461
US

IV. Provider business mailing address

1514 JEFFERSON HWY STE 135
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number28252
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number308461
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: