Healthcare Provider Details

I. General information

NPI: 1063820660
Provider Name (Legal Business Name): DENNIS KALANI KUWAYE JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2014
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 VIA CAMPO
MONTEBELLO CA
90640-1806
US

IV. Provider business mailing address

2533 VIA CAMPO
MONTEBELLO CA
90640-1806
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-7401
  • Fax: 323-721-4428
Mailing address:
  • Phone: 323-721-7401
  • Fax: 323-721-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number63550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: