Provider Demographics
NPI:1093609455
Name:KWON, MOO GYOUN
Entity type:Individual
Prefix:
First Name:MOO
Middle Name:GYOUN
Last Name:KWON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LA CROIX RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7119
Mailing Address - Country:US
Mailing Address - Phone:321-616-2226
Mailing Address - Fax:
Practice Address - Street 1:450 LA CROIX RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7119
Practice Address - Country:US
Practice Address - Phone:321-616-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program