Healthcare Provider Details

I. General information

NPI: 1407617129
Provider Name (Legal Business Name): SARAH Y KWON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E SUNRISE HWY STE 515W
VALLEY STREAM NY
11581-1233
US

IV. Provider business mailing address

129 37TH ST APT 705
UNION CITY NJ
07087-5987
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-1365
  • Fax: 516-710-7685
Mailing address:
  • Phone: 484-649-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1215894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: