Doctor Name: | YONG KU KWON |
NPI Number: | 1033204631 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | 004834 |
Business Practice Address: | 5677 Buford Hwy Ne Ste 210 Doraville, GA - 303401200 |
Business Phone Number: | 6785471045 |
Business Fax Number: | 6785471048 |
Mailing Address: | 5677 Buford Hwy Ne Ste 210, DORAVILLE |
State: | GA |
Postal Code: | 303401200 |
Phone Number: | 6785471045 |
Fax Number: | 6785471048 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 01/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004834 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |