Provider Demographics
NPI:1043224108
Name:KWON, ALAN FAY (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:FAY
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SOUTH ST
Mailing Address - Street 2:SUITE 345
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2305
Mailing Address - Country:US
Mailing Address - Phone:215-732-7600
Mailing Address - Fax:
Practice Address - Street 1:11 EVES DR
Practice Address - Street 2:SUITE 170
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3130
Practice Address - Country:US
Practice Address - Phone:856-797-9600
Practice Address - Fax:856-797-9601
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD055058L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0868267000OtherIBC
NJ720000143Medicare PIN
NJ0868267000OtherIBC
A50079Medicare UPIN
NJ078951Medicare PIN