Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD441573 | PA |
NPI | 1548477631 |
---|---|
Provider Name | Dr. Michael Soon Il Kwon |
First Address | Philadelphia, PA 19134-1095 |
Second Address | Philadelphia, PA 19134-1095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 26/10/2012 |