Provider Demographics
NPI:1437371549
Name:KWON, DAVID TAE (OMD)
Entity Type:Individual
Prefix:MR
First Name:DAVID TAE
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:MR
Other - First Name:TAE
Other - Middle Name:WOON
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2727 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3111
Mailing Address - Country:US
Mailing Address - Phone:213-738-0712
Mailing Address - Fax:213-480-1332
Practice Address - Street 1:2727 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3111
Practice Address - Country:US
Practice Address - Phone:213-738-0712
Practice Address - Fax:213-480-1332
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5098171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0050980OtherMEDICAL