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General NPI Number Information
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NPI Number | 1073951604
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Entity Type | Organization
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Legal Business Name | V & K STRAWBERRY DENTAL
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 2515 STRAWBERRY RD
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City | PASADENA
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State | TX
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Zip | 77502-5101
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Country | US
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Telephone | 713-943-9993
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Fax | 832-201-7478
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Provider Business Mailing Address
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Address Line | 2515 STRAWBERRY RD
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City | PASADENA
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State | TX
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Zip | 77502-5101
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Country | US
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Telephone | 713-943-9993
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Fax | 832-201-7478
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Authorized Official
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Title or Position | DENTIST / OWNER OF THE PRACTICE
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Name | DR. JAE-HYUCK KWAK
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Credential | D.D.S.
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Telephone | 713-943-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23724
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License Number State | TX
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