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General NPI Number Information
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NPI Number | 1306968060
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Entity Type | Organization
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Legal Business Name | SUSAN M. KWONG, DDS, APDC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 30811 UNION CITY BLVD
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City | UNION CITY
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State | CA
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Zip | 94587-2607
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Country | US
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Telephone | 510-429-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 30811 UNION CITY BLVD
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City | UNION CITY
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State | CA
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Zip | 94587-2607
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Country | US
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Telephone | 510-429-8300
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Fax | 510-429-8338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN MARY KWONG
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Credential | DDS
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Telephone | 510-429-8300
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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 |
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License Number State |
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