Provider Demographics
NPI:1699912493
Name:KWON, JUNGWON (MSRD)
Entity type:Individual
Prefix:MS
First Name:JUNGWON
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSRD
Mailing Address - Street 1:216-10 77THAVE. #3N
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:718-918-4434
Mailing Address - Fax:718-918-7417
Practice Address - Street 1:21610 77TH AVE APT 3N
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3442
Practice Address - Country:US
Practice Address - Phone:917-903-5825
Practice Address - Fax:718-918-7417
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered