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General NPI Number Information
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NPI Number | 1790034700
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Entity Type | Organization
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Legal Business Name | S M KIWAN, DDS, INC
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 4820 N. 1ST STREET SUITE 105
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City | FRESNO
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State | CA
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Zip | 93726-0522
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Country | US
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Telephone | 559-224-3110
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Fax | 559-227-7752
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Provider Business Mailing Address
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Address Line | 4820 N. 1ST STREET SUITE 105
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City | FRESNO
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State | CA
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Zip | 93726-0522
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Country | US
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Telephone | 559-224-3110
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Fax | 559-227-7752
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Authorized Official
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Title or Position | PROVIDER/OWNER/PRESIDENT
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Name | DR. SALEEM M KIWAN
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Credential | DDS
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Telephone | 559-224-3110
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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 | 50411
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50411
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License Number State | CA
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