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General NPI Number Information
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NPI Number | 1104988708
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Entity Type | Individual
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Provider Name | JOHN M KWON PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 10900 WARNER AVE STE 111
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3846
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Country | US
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Telephone | 714-964-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ALISAL CT
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City | ALISO VIEJO
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State | CA
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Zip | 92656-1850
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Country | US
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Telephone | 949-215-1566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 25614
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License Number State | CA
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