Individual provider Active NPI

Kyounghwa Kwon, M.A

  • Speech-Language Pathologist
  • Ellicott City, MD
National Provider Identifier
1205071396
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
5086 Dorsey Hall Dr
Ellicott City, MD 21042-7711
Phone
(410) 505-4559
Fax
(410) 505-4993
NPI assigned
Dec 4, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Speech-Language Pathologist 235Z00000X MS Primary

Addresses

Primary practice location

5086 Dorsey Hall Dr
Ellicott City, MD 21042-7711

Mailing address

5086 Dorsey Hall Dr
Ellicott City, MD 21042-7711
Phone (901) 277-6699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131118000210 MD Practitioner - Qualified Speech Language Pathologist 3678709847 Reassigns benefits to 2 organizations
Practice locations: Ellicott City, MD

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
06990MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Capitol Health Care, LLC Multi-Specialty CurrentSince Jul 1, 2020 Accepting new patients
Capitol Health Care, LLC CurrentSince Oct 31, 2021 Accepting new patients
Salus Capital Inc Multi-Specialty CurrentSince Jul 20, 2019 Accepting new patients

Locations

1020 Saint Paul St
Baltimore, MD 21202
Phone (410) 529-0348

5086 Dorsey Hall Dr
Ellicott City, MD 21042
Phone (240) 470-0743

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1205071396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5086 DORSEY HALL DR",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427711",
            "telephone_number": "901-277-6699",
            "fax_number": "410-505-4993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5086 DORSEY HALL DR",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427711",
            "telephone_number": "410-505-4559",
            "fax_number": "410-505-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "KYOUNGHWA",
        "credential": "M.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-04",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.