Provider Demographics
NPI:1740229509
Name:KWON, YOUNG JO (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:JO
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1030 W WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3147
Mailing Address - Country:US
Mailing Address - Phone:714-834-6900
Mailing Address - Fax:714-850-1066
Practice Address - Street 1:1030 W. WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-6809
Practice Address - Country:US
Practice Address - Phone:714-834-6900
Practice Address - Fax:714-850-1066
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010385092084P0800X
CAC1317062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160070510Medicaid
MIB44772Medicare UPIN
MION1582209Medicare PIN
MI0823040Medicare PIN
MI160070510Medicaid