MEDICARE: MYOUNG KWAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	D94087	MD
2	207P00000X	Emergency Medicine Physician	0101276027	VA

General Provider Information

NPI Number	:	1891350013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYOUNG KWAK MD

Provider Business Mailing Address
First Line	:	12600 FAIR LAKES CIR STE 100
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-4904
Country	:	US
Telephone Number	:	703-994-4511
Fax Number	:	703-994-4787

Provider Business Practice Location Address
First Line	:	12600 FAIR LAKES CIR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-4904
Country	:	US
Telephone Number	:	201-747-3229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	03/10/2026

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Directions to “ MYOUNG KWAK MD” Practice Location

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