Basic Information
| Provider Information | |||||||||
| NPI: | 1487315305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWON | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MASTERS IN GC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 E BROAD ST APT 1901 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232191955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439802030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 MARTHA JEFFERSON DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346545950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2022 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | 0140000031 | VA | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.