Provider Demographics
NPI:1497114391
Name:KWON, HEOEEUN
Entity Type:Individual
Prefix:
First Name:HEOEEUN
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WEST 21ST STREET
Mailing Address - Street 2:FLOOR 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:917-500-9060
Mailing Address - Fax:
Practice Address - Street 1:45 W 21ST ST
Practice Address - Street 2:FLOOR 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6865
Practice Address - Country:US
Practice Address - Phone:917-500-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579049163WX0003X
NYF338699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient