Healthcare Provider Details

I. General information

NPI: 1710625017
Provider Name (Legal Business Name): KATHLEEN WON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13055 SW 42ND ST STE 209
MIAMI FL
33175-3410
US

IV. Provider business mailing address

11955 SW 43RD ST
MIAMI FL
33175-4203
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-2235
  • Fax:
Mailing address:
  • Phone: 305-338-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: