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General NPI Number Information
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NPI Number | 1326400748
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Entity Type | Organization
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Legal Business Name | KOBAWOO DENTAL CENTER
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 1222 WELSH RD SUITE G
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City | NORTH WALES
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State | PA
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Zip | 19454-2054
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Country | US
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Telephone | 215-362-3000
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Fax | 267-263-1499
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Provider Business Mailing Address
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Address Line | 1222 WELSH RD SUITE G
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City | NORTH WALES
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State | PA
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Zip | 19454-2054
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Country | US
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Telephone | 215-362-3000
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Fax | 267-263-1499
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HE-KYUNG KIM-YU
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Credential | D.M.D.
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Telephone | 215-362-3000
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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 | DS026455L
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License Number State | PA
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