Provider Demographics
NPI:1417580440
Name:KWON, YOUNG JIN (DPT)
Entity Type:Individual
Prefix:
First Name:YOUNG JIN
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30A MAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2131
Mailing Address - Country:US
Mailing Address - Phone:516-265-1864
Mailing Address - Fax:
Practice Address - Street 1:30A MAIN PKWY
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2131
Practice Address - Country:US
Practice Address - Phone:516-265-1864
Practice Address - Fax:646-797-2098
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040981-1225100000X
NY040981-2225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist