Provider Demographics
NPI:1265544035
Name:KWON, YONG S (MD)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:S
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1695 E RAINFOREST RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5385
Mailing Address - Country:US
Mailing Address - Phone:479-445-6460
Mailing Address - Fax:479-445-6719
Practice Address - Street 1:1695 E RAINFOREST RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5385
Practice Address - Country:US
Practice Address - Phone:479-445-6460
Practice Address - Fax:479-445-6719
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-6941208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8891845Medicare UPIN