Provider Demographics
NPI:1891798674
Name:KWON, JIN HEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:HEE
Last Name:KWON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 W COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3021
Mailing Address - Country:US
Mailing Address - Phone:714-519-3697
Mailing Address - Fax:
Practice Address - Street 1:2204 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3021
Practice Address - Country:US
Practice Address - Phone:714-519-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29535OtherLICENSE
DC29535Medicare ID - Type Unspecified
CADC29535OtherLICENSE