Provider Demographics
NPI:1558762757
Name:KWON, YOUNG M (MPH, RD, CD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:M
Last Name:KWON
Suffix:
Gender:F
Credentials:MPH, RD, CD
Other - Prefix:
Other - First Name:MYA
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RD, CD
Mailing Address - Street 1:2319 N 45TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 107
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6947
Practice Address - Country:US
Practice Address - Phone:206-512-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60497436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered