Individual
AE JI KWON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6400
Mailing address
8115 RIDGE AVE FL 2, PHILADELPHIA, PA 19128-2901
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS044591
PA
171000000X
Military Health Care Provider
DS044591
PA
Other
Enumeration date
06/07/2024
Last updated
07/31/2024
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