MEDICARE: JAMES KWON

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1306143359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KWON

Provider Business Mailing Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W SANTA ANA BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4558
Country	:	US
Telephone Number	:	510-769-4106
Fax Number	:

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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