Healthcare Provider Details

I. General information

NPI: 1114074473
Provider Name (Legal Business Name): MABEL KAR LING KWOK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LAFAYETTE STREET SUITE 202
NEW YORK NY
10013-4138
US

IV. Provider business mailing address

109 LAFAYETTE STREET SUITE 202
NEW YORK NY
10013-4138
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-3857
  • Fax:
Mailing address:
  • Phone: 212-925-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: