Provider Demographics
NPI:1780569194
Name:KWON, JUNMO (OD)
Entity type:Individual
Prefix:
First Name:JUNMO
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S MICHIGAN AVE APT 2008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3462
Mailing Address - Country:US
Mailing Address - Phone:312-216-7142
Mailing Address - Fax:
Practice Address - Street 1:1101 S CANAL ST STE 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4940
Practice Address - Country:US
Practice Address - Phone:312-588-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist