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General NPI Number Information
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NPI Number | 1629280169
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Entity Type | Organization
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Legal Business Name | KWON MD, INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16515 S. 40TH STREET SUITE 135
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-706-9300
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Fax | 480-706-9301
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Provider Business Mailing Address
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Address Line | 16515 S. 40TH STREET SUITE 135
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-706-9300
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Fax | 480-706-9301
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN H KWON
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Credential | M.D.
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Telephone | 480-706-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28252
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License Number State | AZ
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