Provider Demographics
NPI:1427418839
Name:KWON, DOOHYANG
Entity type:Individual
Prefix:
First Name:DOOHYANG
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 NW LOST SPRINGS TER STE 308
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6476
Mailing Address - Country:US
Mailing Address - Phone:858-337-3799
Mailing Address - Fax:
Practice Address - Street 1:410 NW LOST SPRINGS TER STE 308
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6476
Practice Address - Country:US
Practice Address - Phone:858-337-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist