Healthcare Provider Details

I. General information

NPI: 1457051625
Provider Name (Legal Business Name): HAERIM KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 AUBURN AVE
CINCINNATI OH
45219-2802
US

IV. Provider business mailing address

6027 INNOVATION DR
DUBLIN OH
43016-6417
US

V. Phone/Fax

Practice location:
  • Phone: 513-287-6486
  • Fax:
Mailing address:
  • Phone: 614-378-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71017394A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0033230
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: