Provider Demographics
NPI:1629523675
Name:KUEN, HEATHER YOUNG (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:YOUNG
Last Name:KUEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YOUNG HA
Other - Middle Name:
Other - Last Name:KUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5624 PICKWICK RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2057
Mailing Address - Country:US
Mailing Address - Phone:703-727-5716
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005318363A00000X
MDC06216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant