Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 273373 | NY |
N | 208600000X | Surgeon | 273373 | NY |
N | 208200000X | Surgeon | MD60095338 | WA |
N | 208600000X | Surgeon | MD60095338 | WA |
N | 208200000X | Surgeon | ML20008997 | WA |
N | 208600000X | Surgeon | ML20008997 | WA |
Y | 2086X0206X | Surgical Oncologist | 25MA09961000 | NJ |
NPI | 1447458484 |
---|---|
Provider Name | Sung Kwon |
First Address | Teaneck, NJ 07666-4245 |
Second Address | Teaneck, NJ 07666-4245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/05/2017 |