Healthcare Provider Details

I. General information

NPI: 1265105720
Provider Name (Legal Business Name): NATALIE SU-MAN KWOK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 E MARY ANN CLEVELAND WAY
VAIL AZ
85641-8613
US

IV. Provider business mailing address

8082 ADELAIDE HILLS ST
LAS VEGAS NV
89113-4144
US

V. Phone/Fax

Practice location:
  • Phone: 520-316-0613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7503
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012745
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: