Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301082482 | MI |
N | 208600000X | Surgeon | 4301082482 | MI |
N | 208200000X | Surgeon | N2610 | TX |
N | 208600000X | Surgeon | N2610 | TX |
Y | 2086X0206X | Surgical Oncologist | 055750 | MI |
NPI | 1245449743 |
---|---|
Provider Name | David Kwon |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206725801 | (05) | TX |