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1467879411

NPI Code Detail

MEDICARE: STEPHANIE KWON D.O.

MEDICARE: STEPHANIE 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	2080P0203X	Pediatric Critical Care Medicine Physician	83174	SC
2	208000000X	Pediatrics Physician	34013275	OH
3	208000000X	Pediatrics Physician	04053	KY
4	208M00000X	Hospitalist Physician	34-013275	OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467879411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KWON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 776879
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6879
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	171 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8908
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

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

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	12/01/2025

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Directions to “ STEPHANIE KWON D.O.” Practice Location

Language	Start Address	Practice Location

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