Provider Demographics
NPI:1548484926
Name:YOON T. KWON M.D., INC
Entity type:Organization
Organization Name:YOON T. KWON M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON
Authorized Official - Middle Name:T
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-459-4601
Mailing Address - Street 1:1100 SIR FRANCIS DRAKE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1419
Mailing Address - Country:US
Mailing Address - Phone:415-459-4601
Mailing Address - Fax:415-459-4607
Practice Address - Street 1:1100 SIR FRANCIS DRAKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1419
Practice Address - Country:US
Practice Address - Phone:415-459-4601
Practice Address - Fax:415-459-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF15272Medicare UPIN