Provider Demographics
NPI:1457338162
Name:KWUN, ROBERT CHOI (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHOI
Last Name:KWUN
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 1:5169 COTTONWOOD ST STE 630
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6771
Mailing Address - Country:US
Mailing Address - Phone:801-281-3030
Mailing Address - Fax:801-281-3033
Practice Address - Street 1:5169 COTTONWOOD ST STE 630
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6771
Practice Address - Country:US
Practice Address - Phone:801-281-3030
Practice Address - Fax:801-281-3033
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3082804-1205207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
870525682OtherTAX ID #
WY115013800Medicaid
180040257OtherRAILROAD MEDICARE
ID805762700Medicaid
005545103Medicare ID - Type Unspecified
005501701Medicare ID - Type Unspecified
180040257OtherRAILROAD MEDICARE
ID805762700Medicaid
870525682OtherTAX ID #
005545203Medicare ID - Type Unspecified