Healthcare Provider Details

I. General information

NPI: 1154247245
Provider Name (Legal Business Name): PATRICK KWONG P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 W BIRCH ST
SHELTON WA
98584-1735
US

IV. Provider business mailing address

PO BOX 788
SHELTON WA
98584-0788
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-2631
  • Fax: 360-426-0483
Mailing address:
  • Phone: 360-426-2631
  • Fax: 360-426-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK KWONG
Title or Position: DR.
Credential: DDS
Phone: 360-426-2631