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General NPI Number Information
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NPI Number | 1992029599
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Entity Type | Individual
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Provider Name | EDWARD KWON
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Gender | Male
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 2051 MARENGO STREET IPI, C52100
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City | LOS ANGELES
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State | CA
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Zip | 90033-1029
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Country | US
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Telephone | 323-409-7761
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Fax | 323-441-9909
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Provider Business Mailing Address
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Address Line | 510S HEWITT ST 406
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City | LOS ANGELES
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State | CA
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Zip | 90013-1659
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Country | US
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Telephone | 646-702-7609
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | A120642
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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