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General NPI Number Information
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NPI Number | 1689663379
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Entity Type | Individual
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Provider Name | CHUNGDUCK STEPHAN KWON MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 755 NARROWS RD N APT 1207
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1546
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Country | US
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Telephone | 718-815-2393
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Fax | 646-935-1916
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Provider Business Mailing Address
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Address Line | 755 NARROWS RD N
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1548
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Country | US
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Telephone | 718-815-2393
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Fax | 646-935-1916
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 112120
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License Number State | NY
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