Provider Demographics
NPI:1598023582
Name:KWON, HEA RIM
Entity Type:Individual
Prefix:
First Name:HEA
Middle Name:RIM
Last Name:KWON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEARIM
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8248 135TH ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1429
Mailing Address - Country:US
Mailing Address - Phone:919-428-0869
Mailing Address - Fax:
Practice Address - Street 1:8248 135TH ST APT 2H
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1429
Practice Address - Country:US
Practice Address - Phone:919-428-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306025-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health