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General NPI Number Information
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NPI Number | 1790207231
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Entity Type | Individual
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Provider Name | SANGIL KWON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2017
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 24511 W JAYNE AVE
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City | COALINGA
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State | CA
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Zip | 93210-9503
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Country | US
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Telephone | 559-935-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 7231 BOULDER AVE STE 295
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City | HIGHLAND
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State | CA
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Zip | 92346-3313
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Country | US
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Telephone | 909-283-5327
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29142
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021523
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License Number State | NY
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