Provider Demographics
NPI:1780674275
Name:CHA, YONG KWON (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:KWON
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1722 TAGAYTA DR
Mailing Address - Street 2:ROBINSON HEALTH CLINIC
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-729-1013
Mailing Address - Fax:
Practice Address - Street 1:1722 TAGAYTA DR
Practice Address - Street 2:ROBINSON HEALTH CLINIC
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-729-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-01506207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN