Provider Demographics
NPI:1780885491
Name:KWON, EUN JI (MD)
Entity type:Individual
Prefix:DR
First Name:EUN
Middle Name:JI
Last Name:KWON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EUNJI
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CRANBERRY HL STE 105
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7397
Mailing Address - Country:US
Mailing Address - Phone:800-325-7284
Mailing Address - Fax:205-579-9387
Practice Address - Street 1:1 CRANBERRY HL STE 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7397
Practice Address - Country:US
Practice Address - Phone:800-325-7284
Practice Address - Fax:205-579-9387
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69371207N00000X, 207ND0900X
NY251783207N00000X, 207ND0900X
MA1017784207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology