Individual
MS. MI AE KWON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
3739 W. NEPTUNE ST., TAMPA, FL 33629
(813) 856-1292
Mailing address
3739 W. NEPTUNE ST., TAMPA, FL 33629
(813) 856-1292
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN21519
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/07/2015
Last updated
11/09/2018
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