Provider Demographics
NPI:1649304924
Name:KWON, MYOCHUL
Entity type:Individual
Prefix:DR
First Name:MYOCHUL
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1309
Mailing Address - Country:US
Mailing Address - Phone:302-750-0653
Mailing Address - Fax:
Practice Address - Street 1:8 HARRINGTON CT
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-1309
Practice Address - Country:US
Practice Address - Phone:302-750-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG3-00003341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice