Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY00003102 | WA |
NPI | 1053695023 |
---|---|
Provider Name | Dr. Kristina C. Kwon |
First Address | Bellevue, WA 98005-3557 |
Second Address | Bellevue, WA 98005-3557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2011 |
Last Update Date | 07/10/2011 |