Healthcare Provider Details

I. General information

NPI: 1205162773
Provider Name (Legal Business Name): JOHN KUAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 I 30 E STE H
ROYSE CITY TX
75189-7512
US

IV. Provider business mailing address

125 I 30 E STE H
ROYSE CITY TX
75189-7512
US

V. Phone/Fax

Practice location:
  • Phone: 469-723-4000
  • Fax:
Mailing address:
  • Phone: 469-723-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number57805
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: