Provider Demographics
NPI:1427454354
Name:SOHN, KWON (NP)
Entity type:Individual
Prefix:
First Name:KWON
Middle Name:
Last Name:SOHN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8511 S TACOMA WAY # 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-6521
Mailing Address - Country:US
Mailing Address - Phone:253-588-4015
Mailing Address - Fax:253-588-4035
Practice Address - Street 1:8511 S TACOMA WAY # 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-6521
Practice Address - Country:US
Practice Address - Phone:253-588-4015
Practice Address - Fax:253-588-4035
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPNP14004363LF0000X
WAAP60856340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty