=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912392721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYOJIN KWON, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2015
-----------------------------------------------------
Last Update Date | 03/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5156 VILLAGE CREEK DR SUITE 102
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-4495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-735-7900
-----------------------------------------------------
Fax | 972-735-7902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5156 VILLAGE CREEK DR SUITE 102
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-4495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-735-7900
-----------------------------------------------------
Fax | 972-735-7902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. HYOJIN KWON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-567-8758
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | P9082
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------