Provider Demographics
NPI:1770846370
Name:KWON, EUNICE (MSED)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6931 226TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3114
Mailing Address - Country:US
Mailing Address - Phone:646-267-2446
Mailing Address - Fax:
Practice Address - Street 1:6931 226TH ST FL 1
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3114
Practice Address - Country:US
Practice Address - Phone:646-267-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY897442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist