Provider Demographics
NPI:1942449681
Name:KWON, JONG HOON (OMD)
Entity Type:Individual
Prefix:PROF
First Name:JONG HOON
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W.MT. CARMAL AVE.
Mailing Address - Street 2:APT K-1
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3432
Mailing Address - Country:US
Mailing Address - Phone:267-339-1515
Mailing Address - Fax:
Practice Address - Street 1:40 W.MT. CARMAL AVE.
Practice Address - Street 2:APT K-1
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-3432
Practice Address - Country:US
Practice Address - Phone:267-339-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist