Healthcare Provider Details

I. General information

NPI: 1922020130
Provider Name (Legal Business Name): ELIZABETH HYUN-MI KWON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE ST. BARNABAS HOSPITAL--MILLS BUILDING--4TH FLOOR
BRONX NY
10457-2545
US

IV. Provider business mailing address

137 WESTERVELT AVE
TENAFLY NJ
07670-2531
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-9331
  • Fax: 718-960-3792
Mailing address:
  • Phone: 201-568-2423
  • Fax: 718-960-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: