MEDICARE: DR. KWANG JONG WON DPT, MS

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	2251X0800X	Orthopedic Physical Therapist	8916	CO
2	225100000X	Physical Therapist	1173970	TX
3	2251X0800X	Orthopedic Physical Therapist	PT01812	RI
4	2251X0800X	Orthopedic Physical Therapist	PT 60282422	WA

General Provider Information

NPI Number	:	1134309073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWANG JONG WON DPT, MS

Provider Business Mailing Address
First Line	:	3810 N WASHINGTON ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98407-5729
Country	:	US
Telephone Number	:	303-870-7492
Fax Number	:

Provider Business Practice Location Address
First Line	:	10550 HARBOR HILL DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-8944
Country	:	US
Telephone Number	:	253-530-8970
Fax Number	:	253-858-1143

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	06/23/2021

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