Active NPI
Thomas San-Yeop Kwon, DDS
- Dentist
- Alexandria, VA
National Provider Identifier
1184950669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401008655
- Practice address
- 4701 Kenmore Ave,
Suite 122
Alexandria, VA 22304 - Phone
- (703) 751-1112
- Fax
- (703) 370-8875
- NPI assigned
- Oct 19, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401008655 | VA | Primary |
Addresses
Primary practice location
4701 Kenmore Ave,
Suite 122
Alexandria, VA 22304
Mailing address
4701 Kenmore Ave,
Suite 122
Alexandria, VA 22304
Phone (703) 751-1112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401008655 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255910400000",
"number": "1184950669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4701 KENMORE AVE,",
"address_2": "SUITE 122",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "22304",
"telephone_number": "703-751-1112",
"fax_number": "703-370-8875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4701 KENMORE AVE,",
"address_2": "SUITE 122",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "22304",
"telephone_number": "703-751-1112",
"fax_number": "703-370-8875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWON",
"first_name": "THOMAS",
"middle_name": "SAN-YEOP",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-19",
"last_updated": "2009-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401008655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.