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General NPI Number Information
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NPI Number | 1932650983
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Entity Type | Individual
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Provider Name | JUNSOO KWON DMD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 439 BROADWAY
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City | EVERETT
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State | MA
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Zip | 02149-3612
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Country | US
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Telephone | 617-944-9627
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Fax | 617-944-9742
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Provider Business Mailing Address
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Address Line | 439 BROADWAY
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City | EVERETT
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State | MA
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Zip | 02149-3612
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Country | US
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Telephone | 617-944-9627
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Fax | 617-944-9742
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857454
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License Number State | MA
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