MEDICARE: KWON PODIATRY PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1780310003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWON PODIATRY PC

Provider Business Mailing Address
First Line	:	81 PILGRIM LN
Second Line	:
City	:	WESTBURY
State	:	NY
Zip	:	11590-6218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4232 FRANCIS LEWIS BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2561
Country	:	US
Telephone Number	:	646-389-6485
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JAKE S KWON
Credential	:	DPM
Telephone Number	:	917-923-7735

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	03/05/2026

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