Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 28694 | TX |
N | 1223P0221X | Pediatric Dentist | 5636 | WI |
NPI | 1003902032 |
---|---|
Provider Name | Dr. Kee-Won Kwon |
First Address | Plano, TX 75075-3773 |
Second Address | Plano, TX 75075-3773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 05/11/2013 |