Provider Demographics
NPI:1861683047
Name:BYUN, EUN KWANG (MD)
Entity Type:Individual
Prefix:DR
First Name:EUN
Middle Name:KWANG
Last Name:BYUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10419 SLATER AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7704
Mailing Address - Country:US
Mailing Address - Phone:646-717-2533
Mailing Address - Fax:
Practice Address - Street 1:10419 SLATER AVE APT 107
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7704
Practice Address - Country:US
Practice Address - Phone:646-717-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09225700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0356557Medicaid