Provider Demographics
NPI:1336289115
Name:SOUTHAMPTON MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:SOUTHAMPTON MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYOUNG KWON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-357-0733
Mailing Address - Street 1:763 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3438
Mailing Address - Country:US
Mailing Address - Phone:215-357-0733
Mailing Address - Fax:215-357-1434
Practice Address - Street 1:763 GROVE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3438
Practice Address - Country:US
Practice Address - Phone:215-357-0733
Practice Address - Fax:215-357-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKEYSTONE HEALTH PLANOther0022074001