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General NPI Number Information
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NPI Number | 1730802752
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Entity Type | Organization
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Legal Business Name | TAE WOO KWON, DDS, INC
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 3400 MCCALL AVE STE 118
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City | SELMA
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State | CA
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Zip | 93662-2560
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Country | US
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Telephone | 559-896-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 7429 N 1ST ST STE 101
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City | FRESNO
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State | CA
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Zip | 93720-2852
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Country | US
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Telephone | 559-448-9870
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAE WOO KWON
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Credential |
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Telephone | 310-890-0816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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