Provider Demographics
NPI:1609008804
Name:KWON, DAVID MONSOO ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MONSOO ALEXANDER
Last Name:KWON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2637
Mailing Address - Country:US
Mailing Address - Phone:608-257-9700
Mailing Address - Fax:608-250-2015
Practice Address - Street 1:675 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2637
Practice Address - Country:US
Practice Address - Phone:608-257-9700
Practice Address - Fax:608-250-2015
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201200948207Q00000X
WI61343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine