Provider Demographics
NPI:1386969160
Name:KWON, TAESUNG (MD)
Entity type:Individual
Prefix:DR
First Name:TAESUNG
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TAE-SUNG
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-214-9907
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1341
Practice Address - Country:US
Practice Address - Phone:570-271-6408
Practice Address - Fax:570-271-5845
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD454792207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program