Healthcare Provider Details

I. General information

NPI: 1811440258
Provider Name (Legal Business Name): SEOKWON KWON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 COMPTON AVE STE 204
CORONA CA
92881-3416
US

IV. Provider business mailing address

13133 HARBOR BLVD
GARDEN GROVE CA
92843-1717
US

V. Phone/Fax

Practice location:
  • Phone: 951-406-6392
  • Fax:
Mailing address:
  • Phone: 145-378-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857557
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number062458
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108713
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number012252
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: