Provider Demographics
NPI:1164684247
Name:WON, BOK SOON
Entity Type:Individual
Prefix:MRS
First Name:BOK
Middle Name:SOON
Last Name:WON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3428
Mailing Address - Country:US
Mailing Address - Phone:212-222-3576
Mailing Address - Fax:212-222-5172
Practice Address - Street 1:567 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3428
Practice Address - Country:US
Practice Address - Phone:212-222-3576
Practice Address - Fax:212-222-5172
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659543817OtherNPI