Provider Demographics
NPI:1548344914
Name:CHOE, KWON JUNG (OD)
Entity type:Individual
Prefix:DR
First Name:KWON
Middle Name:JUNG
Last Name:CHOE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6961 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8908
Mailing Address - Country:US
Mailing Address - Phone:703-468-1389
Mailing Address - Fax:
Practice Address - Street 1:2539 JOHN MILTON DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2527
Practice Address - Country:US
Practice Address - Phone:703-860-0600
Practice Address - Fax:703-870-7894
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003160152W00000X
VA0618001292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU94126Medicare UPIN
VA00B544A08Medicare PIN