Provider Demographics
NPI:1467469015
Name:KWON, CHRISTOPHER C (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2673
Mailing Address - Country:US
Mailing Address - Phone:281-277-0911
Mailing Address - Fax:
Practice Address - Street 1:16000 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2673
Practice Address - Country:US
Practice Address - Phone:281-277-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48672207P00000X
TXN0192207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN096690000Medicaid
MNENROLLEDMedicaid
MN930002546Medicare PIN
I56351Medicare UPIN