Provider Demographics
NPI:1770759961
Name:KWON, YOON J (DDS)
Entity type:Individual
Prefix:DR
First Name:YOON
Middle Name:J
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 1:36 CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5524
Mailing Address - Country:US
Mailing Address - Phone:212-786-2187
Mailing Address - Fax:
Practice Address - Street 1:1770 GRAND CONCOURSE
Practice Address - Street 2:2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5524
Practice Address - Country:US
Practice Address - Phone:718-901-8110
Practice Address - Fax:718-901-8121
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010004122300000X
NYP588591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist