Provider Demographics
NPI:1336470210
Name:KWON, CHONGIN
Entity Type:Individual
Prefix:MR
First Name:CHONGIN
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BELLEVUE WAY NE STE A3
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4299
Mailing Address - Country:US
Mailing Address - Phone:425-455-1055
Mailing Address - Fax:425-455-1055
Practice Address - Street 1:1105 BELLEVUE WAY NE STE A3
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4299
Practice Address - Country:US
Practice Address - Phone:425-455-1055
Practice Address - Fax:425-455-1055
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60088111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist