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General NPI Number Information
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NPI Number | 1558053728
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Entity Type | Individual
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Provider Name | JAYSON T KWON
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Gender | Male
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 8815 COLUMBIA 100 PKWY STE 4/5
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City | COLUMBIA
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State | MD
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Zip | 21045-2361
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Country | US
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Telephone | 877-776-8502
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Fax |
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Provider Business Mailing Address
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Address Line | 12652 BLACK SADDLE LN
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City | GERMANTOWN
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State | MD
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Zip | 20874-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-273852
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License Number State | MD
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