Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036112116 | IL |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME153058 | FL |
NPI | 1790771657 |
---|---|
Provider Name | Dr. Soo Yun Kwon |
First Address | Rego Park, NY 11374-4511 |
Second Address | Rego Park, NY 11374-4511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 15/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G33566 | (02) | IL |