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General NPI Number Information
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NPI Number | 1003834003
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Entity Type | Individual
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Provider Name | VIVIAN OKHEE KWON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2955 VAN BUREN BLVD STE H4
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City | RIVERSIDE
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State | CA
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Zip | 92503-5674
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Country | US
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Telephone | 951-689-8544
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Fax | 951-689-2465
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Provider Business Mailing Address
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Address Line | 1469 CRESTVIEW RD
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City | REDLANDS
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State | CA
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Zip | 92374-6341
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Country | US
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Telephone | 909-335-2913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43452
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License Number State | CA
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