Provider Demographics
NPI:1992905921
Name:KWON, JOO HAN (DDS)
Entity type:Individual
Prefix:MR
First Name:JOO
Middle Name:HAN
Last Name:KWON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOO
Other - Middle Name:H
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:214 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9208
Mailing Address - Country:US
Mailing Address - Phone:847-587-3020
Mailing Address - Fax:847-587-1598
Practice Address - Street 1:214 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9208
Practice Address - Country:US
Practice Address - Phone:847-587-3020
Practice Address - Fax:847-587-1598
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice