Provider Demographics
NPI:1477629764
Name:KWON, JUDY SEONKYUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:SEONKYUNG
Last Name:KWON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SEONKYUNG
Other - Middle Name:JUDY
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:24560 SOUTHPOINT DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3505
Mailing Address - Country:US
Mailing Address - Phone:571-445-5551
Mailing Address - Fax:571-445-5551
Practice Address - Street 1:24560 SOUTHPOINT DR STE 160
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3505
Practice Address - Country:US
Practice Address - Phone:571-445-5551
Practice Address - Fax:571-445-5551
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist