Healthcare Provider Details

I. General information

NPI: 1164268439
Provider Name (Legal Business Name): W.M. KWON DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 BOLSA AVE
WESTMINSTER CA
92683-5531
US

IV. Provider business mailing address

9010 BOLSA AVE
WESTMINSTER CA
92683-5531
US

V. Phone/Fax

Practice location:
  • Phone: 714-892-5710
  • Fax:
Mailing address:
  • Phone: 714-892-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM KWON
Title or Position: OWNER
Credential: DDS, MD
Phone: 714-892-5710