Healthcare Provider Details

I. General information

NPI: 1972443034
Provider Name (Legal Business Name): HANNA KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4329 209TH ST
BAYSIDE NY
11361-2761
US

IV. Provider business mailing address

14424 26TH AVE
FLUSHING NY
11354-1327
US

V. Phone/Fax

Practice location:
  • Phone: 917-444-1145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: