MEDICARE: OSUNG 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801271150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSUNG KWON MD

Provider Business Mailing Address
First Line	:	1400 PELHAM PKWY S
Second Line	:	JACOBI MEDICAL CENTER,
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	917-325-6051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-6203
Country	:	US
Telephone Number	:	917-325-6051
Fax Number	:

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

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	08/03/2015

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