Chungduck Stephan Kwon, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

112120 Issued in NY

Practice address

755 Narrows Rd N Apt 1207
Staten Island, NY 10304-1546

Phone

(718) 815-2393

Fax

(646) 935-1916

NPI assigned

Oct 17, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• C Stephan Kwon Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1689663379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 NARROWS RD N",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103041548",
            "telephone_number": "718-815-2393",
            "fax_number": "646-935-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 NARROWS RD N APT 1207",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103041546",
            "telephone_number": "718-815-2393",
            "fax_number": "646-935-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "CHUNGDUCK STEPHAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "112120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C STEPHAN",
            "last_name": "KWON",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Amanda Kwasny
• Angela C Kwok
• Michelle Kwok, OTR/L
• Yolande Y Kwok, D.O.
• Yue Faat Raymond Kwok, DO
• Jesse Kyle
• Anthony Kyrollos, PA
• L S Anesthesiologist P
• Camille L'Insalata, PT
• John C L'Insalata, M.D.

• Anatomic Pathology & Clinical Pathology Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Anatomic Pathology & Clinical Pathology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.