Basic Information
Provider Information
NPI: 1295790368
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KWON
FirstName: NATHAN
MiddleName:  
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 98-781 LANIKUAKAA ST
Address2:  
City: AIEA
State: HI
PostalCode: 967012777
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1 JARRETT WHITE RD
Address2: TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
City: TRIPLER AMC
State: HI
PostalCode: 968595001
CountryCode: US
TelephoneNumber: 8084332460
FaxNumber: 8084331558
Other Information
ProviderEnumerationDate: 04/19/2006
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: X
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD-13468HIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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