Provider Demographics
NPI:1265884043
Name:KWON, JIHYE (DMD)
Entity type:Individual
Prefix:
First Name:JIHYE
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 3RD AVE
Mailing Address - Street 2:NYU LUTHERAN DENTAL MEDICINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5800 3RD AVE.
Practice Address - Street 2:NYU LUTHERAN DENTAL MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2018-02-27
Deactivation Date:2017-02-20
Deactivation Code:
Reactivation Date:2018-02-27
Provider Licenses
StateLicense IDTaxonomies
NY059495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist