Provider Demographics
NPI:1578958971
Name:KWON, SUSIE SUHYUN
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:SUHYUN
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 1:122 3RD ST NE STE 101
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4098
Mailing Address - Country:US
Mailing Address - Phone:253-833-7750
Mailing Address - Fax:
Practice Address - Street 1:122 3RD ST NE STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4098
Practice Address - Country:US
Practice Address - Phone:253-833-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611923842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine