Provider Demographics
NPI:1386620292
Name:KWON, OH CHANG (PHD , LAC, OMD)
Entity type:Individual
Prefix:DR
First Name:OH
Middle Name:CHANG
Last Name:KWON
Suffix:
Gender:M
Credentials:PHD , LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 S. HAVANA ST.
Mailing Address - Street 2:#O
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-338-8388
Mailing Address - Fax:303-369-8452
Practice Address - Street 1:2760 S. HAVANA ST.
Practice Address - Street 2:#O
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-338-8388
Practice Address - Fax:303-369-8452
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO301171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist