Provider Demographics
NPI:1003225160
Name:KWON, ALFRED (DPM)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10268 W CENTENNIAL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6423
Mailing Address - Country:US
Mailing Address - Phone:303-933-5048
Mailing Address - Fax:
Practice Address - Street 1:10268 W CENTENNIAL RD STE 104
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6423
Practice Address - Country:US
Practice Address - Phone:303-933-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-03
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000855213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist