Provider Demographics
NPI:1528016243
Name:KWON, OSUN (MD)
Entity Type:Individual
Prefix:
First Name:OSUN
Middle Name:
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 1:1230 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6367
Mailing Address - Country:US
Mailing Address - Phone:610-432-4529
Mailing Address - Fax:610-432-2206
Practice Address - Street 1:1250 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-8506
Practice Address - Fax:610-402-1682
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425636207R00000X, 207RN0300X
VT0420012790207RN0300X
IN01051496A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011501950001Medicaid
PA1011501950001Medicaid
H03519Medicare UPIN