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General NPI Number Information
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NPI Number | 1467879411
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Entity Type | Individual
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Provider Name | STEPHANIE KWON D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 171 ASHLEY AVE
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City | CHARLESTON
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State | SC
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Zip | 29425-8908
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Country | US
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Telephone | 843-792-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 83174
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34013275
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 04053
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34-013275
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License Number State | OH
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