Provider Demographics
NPI:1306886932
Name:KWON, NAE HYON (OD)
Entity type:Individual
Prefix:DR
First Name:NAE HYON
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2120 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9030
Mailing Address - Country:US
Mailing Address - Phone:847-356-2900
Mailing Address - Fax:
Practice Address - Street 1:2120 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9030
Practice Address - Country:US
Practice Address - Phone:847-356-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12749Medicare PIN
ILU94607Medicare UPIN