MEDICARE: ANDIE KWON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	125.083233	IL
2	207N00000X	Dermatology Physician	A203474	CA

General Provider Information

NPI Number	:	1003669201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDIE KWON MD

Provider Business Mailing Address
First Line	:	1200 N STATE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-1001
Country	:	US
Telephone Number	:	323-409-3360
Fax Number	:	323-226-2654

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE STE 1304
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2700
Fax Number	:	847-570-2822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	06/08/2026

Similar Medicare Providers

1770166696 — DAVID THOMAS RHODE MD
Practice Location Address:

2650 RIDGE AVE
EVANSTON, IL
60201-1700

Practice Phone: 847-570-2475
Practice Fax: 847-570-2942

1699303479 — AESHA PATEL MD
Practice Location Address:

2650 RIDGE AVE
EVANSTON, IL
60201-1700

Practice Phone: 847-570-2475
Practice Fax: 847-570-2942

1710125976 — DR. MATTHEW DANIEL DUBE M.D.
Practice Location Address:

2650 RIDGE AVE
EVANSTON, IL
60201-1700

Practice Phone: 847-570-2000
Practice Fax:

1114754793 — JENNIFER RIEDEL
Practice Location Address:

2650 RIDGE AVE STE 1304
EVANSTON, IL
60201-1700

Practice Phone: 847-570-2700
Practice Fax:

1407655657 — JASON WEI
Practice Location Address:

2650 RIDGE AVE STE 1304
EVANSTON, IL
60201-1700

Practice Phone: 847-570-4789
Practice Fax:

1255076527 — COLTON PATE DO
Practice Location Address:

2650 RIDGE AVE STE 1304
EVANSTON, IL
60201-1700

Practice Phone: 847-570-2700
Practice Fax: 847-570-1480

Directions to “ ANDIE KWON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.