Provider Demographics
NPI:1326212739
Name:KWON, YUN KYOUNG (DMD)
Entity Type:Individual
Prefix:
First Name:YUN
Middle Name:KYOUNG
Last Name:KWON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17002 E MAINSTREET STE H
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4961
Mailing Address - Country:US
Mailing Address - Phone:720-842-1900
Mailing Address - Fax:
Practice Address - Street 1:17002 E MAINSTREET STE H
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4961
Practice Address - Country:US
Practice Address - Phone:720-842-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84900351Medicaid