Healthcare Provider Details

I. General information

NPI: 1497114391
Provider Name (Legal Business Name): HEOEEUN KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 21ST ST FLOOR 5
NEW YORK NY
10010-6865
US

IV. Provider business mailing address

45 WEST 21ST STREET FLOOR 5
NEW YORK NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 917-500-9060
  • Fax:
Mailing address:
  • Phone: 917-500-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number579049
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF338699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: