Healthcare Provider Details

I. General information

NPI: 1780645606
Provider Name (Legal Business Name): DANIEL M KWON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N 16TH AVE
YAKIMA WA
98902-1381
US

IV. Provider business mailing address

1470 N 16TH AVE
YAKIMA WA
98902-1381
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-6000
  • Fax: 509-225-2714
Mailing address:
  • Phone: 509-575-6000
  • Fax: 509-225-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA80417
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00049241
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: