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General NPI Number Information
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NPI Number | 1558683649
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Entity Type | Organization
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Legal Business Name | HENRY S. KWON, D.D.S. INC.
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 2836 W RIALTO AVE STE A
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City | RIALTO
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State | CA
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Zip | 92376-6816
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Country | US
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Telephone | 909-820-9454
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Fax | 909-820-9482
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Provider Business Mailing Address
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Address Line | 2836 W RIALTO AVE STE A
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City | RIALTO
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State | CA
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Zip | 92376-6816
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Country | US
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Telephone | 909-820-9454
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Fax | 909-820-9482
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Authorized Official
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Title or Position | PROVIDER/PRESIDENT
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Name | DR. HENRY S. KWON
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Credential | D.D.S.
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Telephone | 909-820-9454
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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 | D47505
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License Number State | CA
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