Provider Demographics
NPI:1154612505
Name:KWON, JOONEUI (PA)
Entity type:Individual
Prefix:MS
First Name:JOONEUI
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 HEAMPSTEAD TURNPIKE
Mailing Address - Street 2:BOX 42
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-572-6131
Mailing Address - Fax:516-572-6153
Practice Address - Street 1:2201 HEAMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-572-6131
Practice Address - Fax:516-572-6153
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant