Provider Demographics
NPI:1326169400
Name:KWON, MI-KYONG M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MI-KYONG
Middle Name:M
Last Name:KWON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 MEGAN LYNN CT
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1655
Mailing Address - Country:US
Mailing Address - Phone:410-241-2520
Mailing Address - Fax:410-442-1075
Practice Address - Street 1:11312 MEGAN LYNN CT
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1655
Practice Address - Country:US
Practice Address - Phone:410-241-2520
Practice Address - Fax:410-442-1075
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional