Provider Demographics
NPI:1104988708
Name:KWON, JOHN M (PT, DPT, OCS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:KWON
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:11 ALISAL CT
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1850
Mailing Address - Country:US
Mailing Address - Phone:949-215-1566
Mailing Address - Fax:
Practice Address - Street 1:10900 WARNER AVE STE 111
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-964-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic