Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bogum Kwon, PA

Individual provider Physician Assistant · NPI 1710401484

Bogum Kwon, PA is a Physician Assistant in Great Neck, New York. Qualified in 2017, 9 years ago. Practices with Aesthetic Plastic Surgery PC, a 10-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
9
Licensed in
NY
In the registry since
2017
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

833 Northern Blvd
Great Neck, NY 11021-5315
Phone: (516) 498-8400
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 021238 (NY)
Physician Assistant Taxonomy 363A00000X
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1710401484
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 3, 2017
Last updated in NPPESJuly 9, 2025
Certification dateJuly 9, 2025
Mailing address833 Northern Blvd Ste 160, Great Neck, NY 11021-5322

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Aesthetic Plastic Surgery Pc — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Great Neck