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General NPI Number Information
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NPI Number | 1548118847
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Entity Type | Organization
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Legal Business Name | JINSAM KWON DDS PLLC
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 16515 MERIDIAN E STE 100B
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City | PUYALLUP
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State | WA
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Zip | 98375-6252
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Country | US
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Telephone | 253-770-0198
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Fax |
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Provider Business Mailing Address
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Address Line | 16515 MERIDIAN E STE 100B
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City | PUYALLUP
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State | WA
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Zip | 98375-6252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | JINSAM KWON
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Credential | DDS
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Telephone | 253-770-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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