Provider Demographics
NPI:1124357207
Name:KWON, MAC (DPT)
Entity Type:Individual
Prefix:
First Name:MAC
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 W NAOMI AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7502
Mailing Address - Country:US
Mailing Address - Phone:626-446-7027
Mailing Address - Fax:626-446-4723
Practice Address - Street 1:671 W NAOMI AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7502
Practice Address - Country:US
Practice Address - Phone:626-446-7027
Practice Address - Fax:626-446-4723
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist