Healthcare Provider Details

I. General information

NPI: 1306764816
Provider Name (Legal Business Name): CATHY KWONG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE SHORE DR STE 112
ALTAMONTE SPRINGS FL
32714-5012
US

IV. Provider business mailing address

100 LAKE SHORE DR STE 112
ALTAMONTE SPRINGS FL
32714-5012
US

V. Phone/Fax

Practice location:
  • Phone: 407-869-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CATHY KWONG
Title or Position: OWNER
Credential: DMD
Phone: 617-903-8633