Provider Demographics
NPI:1801694229
Name:KWEON, DAVID (RBT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KWEON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MAPLE AVE W STE 330
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4301
Mailing Address - Country:US
Mailing Address - Phone:571-533-3456
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE W STE 330
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4301
Practice Address - Country:US
Practice Address - Phone:571-533-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
RBT-21-162893106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician