Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4783 | OK |
Y | 111NI0900X | Internist | 4783 | OK |
NPI | 1003133463 |
---|---|
Provider Name | Julia Margaret Kwon |
First Address | Tulsa, OK 74104-5410 |
Second Address | Tulsa, OK 74104-5410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 10/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200292190A | (05) | OK |