Healthcare Provider Details

I. General information

NPI: 1215049937
Provider Name (Legal Business Name): PETER OH-KYUNG KWON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE: LL-2
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

9120 VENDOM DRIVE
BETHESDA MD
20817-4021
US

V. Phone/Fax

Practice location:
  • Phone: 202-678-2693
  • Fax: 202-610-2699
Mailing address:
  • Phone: 202-678-2693
  • Fax: 202-610-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD12382
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: