Healthcare Provider Details

I. General information

NPI: 1164340980
Provider Name (Legal Business Name): OH BYUNG KWON MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 N VIRGINIA ST
RENO NV
89557-0001
US

IV. Provider business mailing address

584 PUTNAM DR
RENO NV
89503-1636
US

V. Phone/Fax

Practice location:
  • Phone: 775-784-6063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: