Provider Demographics
NPI:1255010351
Name:KWON, HYEON JUN (DDS)
Entity type:Individual
Prefix:
First Name:HYEON JUN
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7007
Mailing Address - Country:US
Mailing Address - Phone:803-798-2377
Mailing Address - Fax:803-798-4292
Practice Address - Street 1:2123 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7007
Practice Address - Country:US
Practice Address - Phone:803-798-2377
Practice Address - Fax:803-798-4292
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0273071223G0001X
SC10906122300000X
NC140751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice