Joo Han Kwon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

214 Washington St
Ingleside, IL 60041-9208

Phone

(847) 587-3020

Fax

(847) 587-1598

NPI assigned

Jul 18, 2007

Last updated

Apr 18, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Joo H Kwon Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1992905921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 WASHINGTON ST",
            "city": "INGLESIDE",
            "state": "IL",
            "postal_code": "600419208",
            "telephone_number": "847-587-3020",
            "fax_number": "847-587-1598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 WASHINGTON ST",
            "city": "INGLESIDE",
            "state": "IL",
            "postal_code": "600419208",
            "telephone_number": "847-587-3020",
            "fax_number": "847-587-1598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "JOO",
        "middle_name": "HAN",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-18",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOO",
            "last_name": "KWON",
            "middle_name": "H",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Caryn Anne Gehrke, LCSW
• Virginia Hammond, MSW
• Forrest Frank Kogut, DC
• Min Jung Kwon, D.D.S.
• Amy Sue Lewis, RN
• Stephanie L Lopez
• Aneta Luszcz, MSW, PEL
• Elizabeth Ann Macy, M.S. CCC-SLP

• General Practice Dentistry in Ingleside, IL
• Providers in Ingleside, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.