Provider Demographics
NPI:1841294337
Name:KWON, ROBERT SUNG GIL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SUNG GIL
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:PO BOX 2052
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-7052
Mailing Address - Country:US
Mailing Address - Phone:562-799-3198
Mailing Address - Fax:562-799-3509
Practice Address - Street 1:3951 KATELLA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3303
Practice Address - Country:US
Practice Address - Phone:562-799-3198
Practice Address - Fax:562-799-3509
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA639982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4144250OtherCIGNA
CAP01730037OtherRR MEDICARE
CA7060429OtherAETNA
CA00A639980Medicaid
WA63998DMedicare PIN
CACB263845Medicare PIN
CA7060429OtherAETNA
CA00A639980Medicaid
WA63998CMedicare PIN
CAP01730037OtherRR MEDICARE
WA63998GMedicare PIN
WA63998FMedicare PIN
WA63998EMedicare PIN