Provider Demographics
NPI:1417009630
Name:KWON, ANNETTE Y (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:Y
Last Name:KWON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 423
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3050
Mailing Address - Fax:415-563-4867
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 423
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3050
Practice Address - Fax:415-563-4867
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90599208M00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A905990Medicaid
I47398Medicare UPIN
00A905990Medicare ID - Type Unspecified