| Okap Kwon Md Inc | |
|
964 East Main Street Ravenna OH 44266 | |
| (330) 296-3483 | |
| (330) 296-0756 |
| Full Name | Okap Kwon Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 964 East Main Street, Ravenna, Ohio |
| Authorized Official Name and Position | Okap Kwon (PRESIDENT) |
| Authorized Official Contact | 3302963483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Okap Kwon Md Inc 964 East Main Street Ravenna OH 44266 Ph: (330) 296-3483 | Okap Kwon Md Inc 964 East Main Street Ravenna OH 44266 Ph: (330) 296-3483 |
| NPI Number | 1811384118 |
|---|---|
| Provider Enumeration Date | 04/24/2015 |
| Last Update Date | 04/24/2015 |
| Medicare PECOS PAC ID | 5698088870 |
|---|---|
| Medicare Enrollment ID | O20150716002167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811384118 | NPI | - | NPPES |
| 0340545 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 35040512 (Ohio) | Primary |
| Provider Name | Okap Kwon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124050968 PECOS PAC ID: 3971792409 Enrollment ID: I20110113000797 |
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