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General NPI Number Information
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NPI Number | 1053573758
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Entity Type | Organization
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Legal Business Name | J JENNIFER KWON, OD, LLC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 7031 LITTLE RIVER TPKE 12B
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City | ANNANDALE
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State | VA
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Zip | 22003-5958
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Country | US
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Telephone | 703-354-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 7031 LITTLE RIVER TPKE 12B
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City | ANNANDALE
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State | VA
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Zip | 22003-5958
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Country | US
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Telephone | 703-354-1212
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. JIYONG JENNIFER KWON
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Credential | OD
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Telephone | 703-354-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001700
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License Number State | VA
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