Provider Demographics
NPI:1487703310
Name:KWON, HAE YOON (PT)
Entity type:Individual
Prefix:
First Name:HAE
Middle Name:YOON
Last Name:KWON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HAE
Other - Middle Name:KWON
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2953 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1708
Mailing Address - Country:US
Mailing Address - Phone:205-624-2436
Mailing Address - Fax:205-624-2439
Practice Address - Street 1:1310 ALFORD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3199
Practice Address - Country:US
Practice Address - Phone:205-824-8850
Practice Address - Fax:205-824-8853
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051513721KWOOtherBLUE CROSS BLUE SHIELD