Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | NOTYET | AL |
Y | 1223G0001X | General Practice | 36189 | TX |
Y | 213EG0000X | General Practice | 36189 | TX |
NPI | 1760963904 |
---|---|
Provider Name | Dr. So Dam Kwon |
First Address | Plano, TX 75024-5035 |
Second Address | Frisco, TX 75034-7471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2018 |
Last Update Date | 23/03/2021 |