Provider Demographics
NPI:1457318107
Name:DR KWONS FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:DR KWONS FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:OHJOON
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-983-9000
Mailing Address - Street 1:8820 59TH AVE SW
Mailing Address - Street 2:#100
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-983-9000
Mailing Address - Fax:253-983-9155
Practice Address - Street 1:8820 59TH AVE SW
Practice Address - Street 2:#100
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-983-9000
Practice Address - Fax:253-983-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0034844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107630Medicaid
G8858604Medicare ID - Type UnspecifiedGR #
G8858605Medicare ID - Type UnspecifiedINDVIDUAL
WA1107630Medicaid