| NPI | 1255898706 |
|---|---|
| Former Legal Business Name | GRACE KWON CORPORATION |
| Entity Type | Organization |
| Authorized Contact | LUISA DAVIS Billing 714-997-2674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 106S00000X Behavior Technician | |
| 164X00000X Licensed Vocational Nurse | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-05-09 |