Provider Demographics
NPI:1225265861
Name:KWON, JEONTAIK JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JEONTAIK
Middle Name:JOHN
Last Name:KWON
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:331 NEWMAN SPRINGS ROAD
Mailing Address - Street 2:BLDG. 2, SUITE 220
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:655 SHREWSBURY AVE STE 210
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4151
Practice Address - Country:US
Practice Address - Phone:732-747-4744
Practice Address - Fax:732-747-4751
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4448122086S0129X
NY2843622086S0129X, 2086S0129X
NJ25MA100167002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery