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General NPI Number Information
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NPI Number | 1154878999
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Entity Type | Organization
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Legal Business Name | KWOK CHEN AND KIM DENTAL GROUP
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 1928 HUNTINGTON DR
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4874
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Country | US
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Telephone | 626-799-1252
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Fax |
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Provider Business Mailing Address
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Address Line | 1928 HUNTINGTON DR
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4874
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Country | US
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Telephone | 626-799-1252
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Fax |
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Authorized Official
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Title or Position | OWERN/DOCTOR
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Name | DR. RAYMOND KWOK
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Credential | DMD
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Telephone | 626-799-1258
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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 | 56529
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License Number State | CA
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