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NPI Code Detail

MEDICARE: DAVID KWON NP

MEDICARE: DAVID KWON NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner12360OH

Other Identifiers

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

General Provider Information

NPI Number : 1740577055
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID KWON NP
Provider Business Mailing Address
First Line : 5209 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-2224
Country : US
Telephone Number : 216-651-2037
Fax Number :
Provider Business Practice Location Address
First Line : 4500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3736
Country : US
Telephone Number : 216-325-9296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2011
Last Update Date : 12/17/2013

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