Healthcare Provider Details

I. General information

NPI: 1811384118
Provider Name (Legal Business Name): OKAP KWON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 EAST MAIN STREET
RAVENNA OH
44266
US

IV. Provider business mailing address

964 EAST MAIN STREET
RAVENNA OH
44266
US

V. Phone/Fax

Practice location:
  • Phone: 330-296-3483
  • Fax: 330-296-0756
Mailing address:
  • Phone: 330-296-3483
  • Fax: 330-296-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35040512
License Number StateOH

VIII. Authorized Official

Name: OKAP KWON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-296-3483