Provider Demographics
NPI:1528383122
Name:KWON, SUN DUCK (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUN DUCK
Middle Name:
Last Name:KWON
Suffix:
Gender:F
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:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5915
Mailing Address - Fax:757-446-5696
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5915
Practice Address - Fax:757-446-5696
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256023208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528383122OtherUNITED HEALTHCARE
NC1528383122Medicaid
VAPAROtherCIGNA
VA1528383122Medicaid
VA1528383122OtherVIRGINIA PREMIER HEALTH PLAN
VA1528383122OtherCOVENTRY NETWORK
VA522317OtherANTHEM BC/BS
VAPAROtherCORVEL
VAPAROtherAETNA
VA10129766OtherOPTIMA HEALTH
VAPAROtherMULTIPLAN
VA-017OtherTRICARE/CHAMPUS
VA1202589OtherUSA MANAGED CARE
NC1528383122Medicaid
VAVVE130AMedicare PIN