Healthcare Provider Details

I. General information

NPI: 1245150622
Provider Name (Legal Business Name): OHGEUN MICHAEL KWON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 OAKVILLE DR APT 2B
PITTSBURGH PA
15220-4415
US

IV. Provider business mailing address

136 OAKVILLE DR APT 2B
PITTSBURGH PA
15220-4415
US

V. Phone/Fax

Practice location:
  • Phone: 412-721-0053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG016675
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: