Provider Demographics
NPI:1992145460
Name:KWON, JI YON (MD)
Entity type:Individual
Prefix:
First Name:JI YON
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LONGSTONE LN STE 106
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1532
Mailing Address - Country:US
Mailing Address - Phone:410-480-1895
Mailing Address - Fax:410-480-4955
Practice Address - Street 1:2400 LONGSTONE LN STE 106
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1532
Practice Address - Country:US
Practice Address - Phone:410-480-1895
Practice Address - Fax:410-480-4955
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81315207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine