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General NPI Number Information
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NPI Number | 1255898706
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Entity Type | Organization
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Legal Business Name | GRACE KWON CORPORATION
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 17452 IRVINE BLVD STE 213
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City | TUSTIN
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State | CA
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Zip | 92780-3031
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Country | US
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Telephone | 657-371-6977
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Fax |
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Provider Business Mailing Address
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Address Line | 17452 IRVINE BLVD STE 213
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City | TUSTIN
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State | CA
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Zip | 92780-3031
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Country | US
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Telephone | 657-346-2080
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GRACE KWON
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Credential | DO
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Telephone | 310-753-5805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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