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General NPI Number Information
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NPI Number | 1780380170
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Entity Type | Individual
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Provider Name | SEUNGJAE KWON
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Gender | Male
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 3921 COCHRAN ST
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City | SIMI VALLEY
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State | CA
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Zip | 93063-2364
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Country | US
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Telephone | 805-327-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 1239 EVERGREEN AVE APT A3
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City | FULLERTON
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State | CA
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Zip | 92835-2053
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Country | US
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Telephone | 714-823-7375
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 303592
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License Number State | CA
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