Provider Demographics
NPI:1891767497
Name:KWON, SUNG (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 JACK MARTIN BOULEVARD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-202-1500
Mailing Address - Fax:732-202-1058
Practice Address - Street 1:425 JACK MARTIN BOULEVARD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-202-1500
Practice Address - Fax:732-202-1058
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH71774Medicare UPIN
NJ063296C8PMedicare ID - Type Unspecified