1992905921 NPI number — MR. JOO HAN KWON DDS

Table of content: MR. JOO HAN KWON DDS (NPI 1992905921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992905921 NPI number — MR. JOO HAN KWON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWON
Provider First Name:
JOO
Provider Middle Name:
HAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KWON
Provider Other First Name:
JOO
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992905921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLESIDE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60041-9208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-587-3020
Provider Business Mailing Address Fax Number:
847-587-1598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLESIDE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60041-9208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-587-3020
Provider Business Practice Location Address Fax Number:
847-587-1598
Provider Enumeration Date:
07/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)