Healthcare Provider Details

I. General information

NPI: 1992246888
Provider Name (Legal Business Name): HYUE KYUNG KWON, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 BRADDOCK RD SUITE 101
CENTREVILLE VA
20121-2459
US

IV. Provider business mailing address

13880 BRADDOCK RD SUITE 101
CENTREVILLE VA
20121-2459
US

V. Phone/Fax

Practice location:
  • Phone: 703-815-6455
  • Fax:
Mailing address:
  • Phone: 703-815-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HYUE K. KWON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 703-815-6455