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General NPI Number Information
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NPI Number | 1679742456
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Entity Type | Individual
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Provider Name | DR. KEEHONG KWON
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Gender | Male
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 8727A COOPER RD
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City | ALEXANDRIA
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State | VA
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Zip | 22309-3906
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Country | US
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Telephone | 571-312-6898
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Fax |
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Provider Business Mailing Address
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Address Line | 6648 FISHER AVE
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City | FALLS CHURCH
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State | VA
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Zip | 22046-1819
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Country | US
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Telephone | 201-982-1206
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02322100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401413034
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License Number State | VA
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