MEDICARE: CHRISTINA DASL 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	207N00000X	Dermatology Physician	U6742	TX

General Provider Information

NPI Number	:	1619482213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA DASL KWON MD

Provider Business Mailing Address
First Line	:	27131 FULSHEAR BEND DR
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-1231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27131 FULSHEAR BEND DR
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-1231
Country	:	US
Telephone Number	:	281-612-0050
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	10/03/2024

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