Provider Demographics
NPI:1376741884
Name:KWON, ELLEN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARIE
Last Name:KWON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:MILLER KWON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:65 N MADISON AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2049
Mailing Address - Country:US
Mailing Address - Phone:562-832-7262
Mailing Address - Fax:
Practice Address - Street 1:65 N MADISON AVE STE 405
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2049
Practice Address - Country:US
Practice Address - Phone:562-832-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist