Provider Demographics
NPI:1356469175
Name:SOON KWON, MD.
Entity Type:Organization
Organization Name:SOON KWON, MD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-471-1354
Mailing Address - Street 1:2 CATHARINE ST
Mailing Address - Street 2:P.O. BOX 550
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3100
Mailing Address - Country:US
Mailing Address - Phone:800-344-3263
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:55 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4106
Practice Address - Country:US
Practice Address - Phone:845-471-1354
Practice Address - Fax:845-790-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00517762Medicaid
NY7L7183Medicare PIN
NY7L7182Medicare PIN
NYC12196Medicare UPIN
NYCC9638Medicare PIN
NY00517762Medicaid