Healthcare Provider Details

I. General information

NPI: 1740577055
Provider Name (Legal Business Name): DAVID S KWON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 EUCLID AVE
CLEVELAND OH
44103-3736
US

IV. Provider business mailing address

5209 DETROIT AVE
CLEVELAND OH
44102-2224
US

V. Phone/Fax

Practice location:
  • Phone: 216-325-9296
  • Fax:
Mailing address:
  • Phone: 216-651-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.329027
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.12360
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: