Healthcare Provider Details

I. General information

NPI: 1497199210
Provider Name (Legal Business Name): SOO YOUNG KWON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 17TH AVE
SEATTLE WA
98122-5711
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2800
  • Fax: 206-320-2827
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD.36753
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61253383
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD61253383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: