Provider Demographics
NPI:1942422886
Name:KWON, JOONG YONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JOONG YONG
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 1:11803 SOUTH FWY STE 111
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7028
Mailing Address - Country:US
Mailing Address - Phone:817-349-9500
Mailing Address - Fax:173-499-5018
Practice Address - Street 1:11803 SOUTH FWY STE 111
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7028
Practice Address - Country:US
Practice Address - Phone:817-349-9500
Practice Address - Fax:817-349-9501
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005180207RG0300X
IA40979207RI0200X
NE27313207RI0200X
TXR9800207RI0200X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease