Basic Information
Provider Information
NPI: 1396139515
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KWON
FirstName: DANIEL
MiddleName: HYUCK-MIN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 505 PARNASSUS AVE # M1286
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941432204
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 505 PARNASSUS AVE
Address2: ROOM 987
City: SAN FRANCISCO
State: CA
PostalCode: 941430119
CountryCode: US
TelephoneNumber: 4154761528
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2015
LastUpdateDate: 07/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X146273CAY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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