Healthcare Provider Details

I. General information

NPI: 1326972605
Provider Name (Legal Business Name): RANDY KWON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N MAIN ST
TOOELE UT
84074-1616
US

IV. Provider business mailing address

168 W LOUISE AVE
SOUTH SALT LAKE UT
84115-1258
US

V. Phone/Fax

Practice location:
  • Phone: 435-833-9300
  • Fax:
Mailing address:
  • Phone: 610-731-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14291636-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: