Provider Demographics
NPI:1134309073
Name:WON, KWANG JONG (DPT, MS)
Entity Type:Individual
Prefix:DR
First Name:KWANG
Middle Name:JONG
Last Name:WON
Suffix:
Gender:M
Credentials:DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3810 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5729
Mailing Address - Country:US
Mailing Address - Phone:303-870-7492
Mailing Address - Fax:
Practice Address - Street 1:10550 HARBOR HILL DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8944
Practice Address - Country:US
Practice Address - Phone:253-530-8970
Practice Address - Fax:253-858-1143
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89162251X0800X
TX1173970225100000X
RIPT018122251X0800X
WAPT 602824222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist