MEDICARE: SO MEE 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	183500000X	Pharmacist	86599	CA

General Provider Information

NPI Number	:	1457071623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SO MEE KWON

Provider Business Mailing Address
First Line	:	1100 S HILL ST APT 309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-4298
Country	:	US
Telephone Number	:	949-599-8152
Fax Number	:

Provider Business Practice Location Address
First Line	:	21010 GOLDEN SPRINGS DR
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-595-4003
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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Directions to “ SO MEE KWON ” Practice Location

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