Provider Demographics
NPI:1346285525
Name:KWON, DAVID HONGSEOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HONGSEOK
Last Name:KWON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 FAWNCREST CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2518
Mailing Address - Country:US
Mailing Address - Phone:832-646-1253
Mailing Address - Fax:
Practice Address - Street 1:8476 SIMONDS ST
Practice Address - Street 2:
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5700
Practice Address - Country:US
Practice Address - Phone:301-677-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368231223P0300X
TX253091223P0300X
VA04014153951223P0300X
NC93031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics