Provider Demographics
NPI:1912510652
Name:SHON, WON KYU
Entity Type:Individual
Prefix:
First Name:WON KYU
Middle Name:
Last Name:SHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHALLENGER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2101
Mailing Address - Country:US
Mailing Address - Phone:201-225-0057
Mailing Address - Fax:201-225-2267
Practice Address - Street 1:105 CHALLENGER RD STE 401
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2101
Practice Address - Country:US
Practice Address - Phone:201-225-0057
Practice Address - Fax:201-225-2267
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03825800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist