Healthcare Provider Details

I. General information

NPI: 1700986684
Provider Name (Legal Business Name): ELLEN EUN-JOO KWON ).D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

633 GRAND CHAMPION DR
ROCKVILLE MD
20850-5970
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8344
  • Fax:
Mailing address:
  • Phone: 301-519-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1605
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1605
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTA1605
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: