Provider Demographics
NPI:1073841151
Name:KWON, YOUNG JE
Entity type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:JE
Last Name:KWON
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 1:8141 8TH ST
Mailing Address - Street 2:APT 6
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3066
Mailing Address - Country:US
Mailing Address - Phone:562-292-5993
Mailing Address - Fax:
Practice Address - Street 1:14832 BEACH BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4200
Practice Address - Country:US
Practice Address - Phone:714-670-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist