Provider Demographics
NPI:1225265861
Name:KWON, JEONTAIK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEONTAIK
Middle Name:JOHN
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3100N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:241 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1154
Practice Address - Country:US
Practice Address - Phone:845-483-5934
Practice Address - Fax:845-483-5783
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2021-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT194818208600000X
PAMD4448122086S0129X
NY2843622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery