Provider Demographics
NPI:1366536153
Name:KIM, WON IL (MD)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:IL
Last Name:KIM
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 1:2 WISCONSIN CIR STE 230
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7005
Mailing Address - Country:US
Mailing Address - Phone:301-281-4085
Mailing Address - Fax:202-688-2857
Practice Address - Street 1:2 WISCONSIN CIR STE 230
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7005
Practice Address - Country:US
Practice Address - Phone:301-215-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057030A207W00000X
VA0101273553207W00000X
DCMD210001940207W00000X
MDD0093134207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB106814Medicare PIN
GAVAD000Medicare UPIN