Provider Demographics
NPI:1861408874
Name:KWON, YOON TAIK (MD)
Entity type:Individual
Prefix:DR
First Name:YOON
Middle Name:TAIK
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SIR FRANCIS DRAKE BLVD
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
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44787207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44787OtherSTATE LICENSE