Provider Demographics
NPI:1215049937
Name:KWON, PETER OH-KYUNG (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:OH-KYUNG
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 1:9120 VENDOM DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4021
Mailing Address - Country:US
Mailing Address - Phone:202-678-2693
Mailing Address - Fax:202-610-2699
Practice Address - Street 1:2041 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:SUITE: LL-2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7024
Practice Address - Country:US
Practice Address - Phone:202-678-2693
Practice Address - Fax:202-610-2699
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023296700Medicaid
DC023296700Medicaid