Bogum Kwon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

021238 Issued in NY

Practice address

833 Northern Blvd
Great Neck, NY 11021-5315

Phone

(516) 498-8400

NPI assigned

Aug 3, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aesthetic Plastic Surgery PCGroup PAC ID 7012924939, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Francis Hospital - the Heart Center Hospital, Roslyn, NY, CCN 330182
• Northwell Hospital Glen Cove Hospital, Glen Cove, NY, CCN 330181
• North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bkwon634106@nyumc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aesthetic Plastic Surgery PC

  • Plastic and Reconstructive Surgery Physician
  • Great Neck, NY
  • NPI 1114191905
  Medicare reassignment Care Compare group
• New York Cardiovascular Anesthesiologists, P.C.

  • Anesthesiology Physician
  • Roslyn, NY
  • NPI 1801834411
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Glen Cove Hospital

  • General Acute Care Hospital
  • Glen Cove, NY
  • NPI 1295743060
  Care Compare affiliation
• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570
  Care Compare affiliation
• St. Francis Hospital

  • General Acute Care Hospital
  • Roslyn, NY
  • NPI 1043279565
  Care Compare affiliation

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

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1710401484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 NORTHERN BLVD STE 160",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215322",
            "telephone_number": "516-498-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215315",
            "telephone_number": "516-498-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "BOGUM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-03",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve Kurtin
• Lewis Myles Kurtz, MD
• KVL Dental Group P.C.
• Gina Sue Kwak, M.D.
• Anna Izabela Kwasnik, DDS
• L Kanders NP in Adult Health PLLC
• Nicholas Alexander La Gamma, M.D.
• Jean Ronald Labady, PT
• Ronald Andrade Labayen
• Gregory Lachhman

• Physician Assistant in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.