Provider Demographics
NPI:1740964170
Name:OHMIN KWON MD PLLC
Entity type:Organization
Organization Name:OHMIN KWON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OHMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-970-4481
Mailing Address - Street 1:24 W CAMELBACK RD STE A330
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2529
Mailing Address - Country:US
Mailing Address - Phone:310-970-4481
Mailing Address - Fax:948-356-8192
Practice Address - Street 1:5652 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4713
Practice Address - Country:US
Practice Address - Phone:310-970-4481
Practice Address - Fax:948-356-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty