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MARY KWON MD

Physicians Physical Medicine & Rehabilitation Pain Medicine

Provider NPI: 1790797645

Provider Information:
 MARY  KWON MD
Gender: F
Not Sole Proprietor

Practice Location:
2550 UNIVERSITY AVE W SUITE 189S SAINT PAUL, MN 55114-1052 US
Tel: 651-332-7474  Fax: 651-332-7475

Business Mailing Address:
2550 UNIVERSITY AVE W SUITE 189S SAINT PAUL, MN 55114-1052 US
Tel: 651-332-7474  Fax: 651-332-7475

NPI Information:
NPI: 1790797645
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2081P2900XPhysicians
Physical Medicine & Rehabilitation
Pain Medicine
MN27500

Other Provider Identifiers:

IssuerNumberStateType
BLUE CROSS09128KWMN01
357573000MN05
PREFERRED ONE376001MN01
MEDICA23-08420MN01



American Medical Association 2012 taxonomy code information

Code: 2081P2900X

Type:

Classification:



Definition:



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