MEDICARE: DR. NATALIE SU-MAN KWOK DMD

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	7503	NV

General Provider Information

NPI Number	:	1265105720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE SU-MAN KWOK DMD

Provider Business Mailing Address
First Line	:	9156 DOMINA ROYAL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5270 S FORT APACHE RD STE 350
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1724
Country	:	US
Telephone Number	:	702-273-3404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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