MEDICARE: SANGHEE KWEON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	7666569-4405	UT
2	163W00000X	Registered Nurse	7666569-3102	UT

General Provider Information

NPI Number	:	1720457427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANGHEE KWEON

Provider Business Mailing Address
First Line	:	PO BOX 572070
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-2070
Country	:	US
Telephone Number	:	801-263-7138
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5543
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	10/16/2025

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Directions to “ SANGHEE KWEON ” Practice Location

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