Provider Demographics
NPI:1922020130
Name:KWON, ELIZABETH HYUN-MI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HYUN-MI
Last Name:KWON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:137 WESTERVELT AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2531
Mailing Address - Country:US
Mailing Address - Phone:201-568-2423
Mailing Address - Fax:718-960-3792
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:ST. BARNABAS HOSPITAL--MILLS BUILDING--4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-9331
Practice Address - Fax:718-960-3792
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209525208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01986561Medicaid
NY01986561Medicaid