Individual
DR. SUNG KWONG OR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1538 MARSETTA DR, BEAVERCREEK, OH 45432-2733
(937) 427-2828
(937) 427-2880
Mailing address
1538 MARSETTA DR, BEAVERCREEK, OH 45432-2733
(937) 427-2828
(937) 427-2880
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
34008241O
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384230
ANTHEM
OH
05
—
2492324
—
OH
01
—
510552661027
CARE SOURCE
OH
Enumeration date
05/02/2006
Last updated
04/12/2022
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