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General NPI Number Information
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NPI Number | 1356771315
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Entity Type | Organization
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Legal Business Name | ELLEN MILLER KWON, PSYD
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 65 N MADISON AVE SUITE 405
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City | PASADENA
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State | CA
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Zip | 91101-2035
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Country | US
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Telephone | 626-807-5451
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Fax | 626-395-7751
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Provider Business Mailing Address
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Address Line | 65 N MADISON AVE SUITE 405
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City | PASADENA
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State | CA
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Zip | 91101-2035
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Country | US
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Telephone | 626-807-5451
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Fax | 626-395-7751
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLEN MARIE KWON
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Credential | PSY,D,
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Telephone | 626-807-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 24302
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License Number State | CA
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