MEDICARE: KWOK CHEN AND KIM DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	56529	CA

General Provider Information

NPI Number	:	1154878999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWOK CHEN AND KIM DENTAL GROUP

Provider Business Mailing Address
First Line	:	1928 HUNTINGTON DR
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4874
Country	:	US
Telephone Number	:	626-799-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 HUNTINGTON DR
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4874
Country	:	US
Telephone Number	:	626-799-1252
Fax Number	:

Authorized Official
Title or Position	:	OWERN/DOCTOR
Name	:	DR. RAYMOND KWOK
Credential	:	DMD
Telephone Number	:	626-799-1258

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	09/09/2016

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