MEDICARE: GRACE EUN KWON D.O.

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	2084P0800X	Psychiatry Physician	20A12013	CA
2	2084P0802X	Addiction Psychiatry Physician	20A12013	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	D400248447	OTHER	CT	KWON MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326347873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE EUN KWON D.O.

Provider Business Mailing Address
First Line	:	10212 COWAN HEIGHTS DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-1566
Country	:	US
Telephone Number	:	310-753-5805
Fax Number	:	800-896-2401

Provider Business Practice Location Address
First Line	:	17452 IRVINE BLVD STE 213
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3031
Country	:	US
Telephone Number	:	714-371-6977
Fax Number	:	800-836-2401

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

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	05/07/2026

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Directions to “ GRACE EUN KWON D.O.” Practice Location

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