MEDICARE: PYOUNG IL 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	207RG0100X	Gastroenterology Physician	A24218	CA

General Provider Information

NPI Number	:	1326054537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PYOUNG IL KWON MD

Provider Business Mailing Address
First Line	:	4220 W. 3RD ST SUITE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020
Country	:	US
Telephone Number	:	213-487-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 W. 3RD ST
Second Line	:	201
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3450
Country	:	US
Telephone Number	:	213-487-4141
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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Directions to “ PYOUNG IL KWON MD” Practice Location

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