MEDICARE: MICHELLE M KWON R.PH

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	183500000X	Pharmacist	43163	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	313963	OTHER	CA	NABP

General Provider Information

NPI Number	:	1972881043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M KWON R.PH

Provider Business Mailing Address
First Line	:	2072 LYANS DR
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-1537
Country	:	US
Telephone Number	:	818-248-0408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 N WESTERN AVE
Second Line	:	117
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2307
Country	:	US
Telephone Number	:	323-465-3112
Fax Number	:

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

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	07/23/2011

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