Provider Demographics
NPI:1326036690
Name:KWUN, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KWUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:18100 NE UNION HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3330
Practice Address - Country:US
Practice Address - Phone:206-320-5190
Practice Address - Fax:206-320-5191
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11542207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A925740Medicaid
NV100507094Medicaid
CAXPY203260Medicaid
CA00A925741Medicare PIN
NVV102884Medicare PIN
I31477Medicare UPIN
CAXPY203260Medicaid