Provider Demographics
NPI:1003840471
Name:KWON, PETER B (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27432
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0114
Mailing Address - Country:US
Mailing Address - Phone:714-961-5423
Mailing Address - Fax:714-951-5374
Practice Address - Street 1:1275 N ROSE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3941
Practice Address - Country:US
Practice Address - Phone:714-961-5423
Practice Address - Fax:714-961-5374
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA46220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE49929Medicare UPIN
CAA46220Medicare ID - Type Unspecified