Provider Demographics
NPI:1558504340
Name:KWON, JUNGHAE HELEN (MD)
Entity type:Individual
Prefix:
First Name:JUNGHAE
Middle Name:HELEN
Last Name:KWON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19800 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1816
Mailing Address - Country:US
Mailing Address - Phone:440-995-0555
Mailing Address - Fax:440-995-1444
Practice Address - Street 1:19800 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1816
Practice Address - Country:US
Practice Address - Phone:440-995-0555
Practice Address - Fax:440-995-1444
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-033979208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice