Provider Demographics
NPI:1023287786
Name:KWON, YONG (MD)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UOO
Other - Middle Name:RYONG
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:250 TRAVELODGE DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4126
Mailing Address - Country:US
Mailing Address - Phone:866-459-2912
Mailing Address - Fax:
Practice Address - Street 1:250 TRAVELODGE DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4126
Practice Address - Country:US
Practice Address - Phone:866-459-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-120601207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK52977 FOR #207073Medicare PIN
ILK52976-FOR #207067Medicare PIN