Healthcare Provider Details

I. General information

NPI: 1578958971
Provider Name (Legal Business Name): SUSIE SUHYUN KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12039 NE 128TH ST STE 500
KIRKLAND WA
98034-3029
US

IV. Provider business mailing address

12039 NE 128TH ST STE 500
KIRKLAND WA
98034-3029
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-1220
  • Fax:
Mailing address:
  • Phone: 425-899-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number61192384
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: