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General NPI Number Information
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NPI Number | 1922664127
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Entity Type | Organization
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Legal Business Name | KWON DENTAL GROUP INC
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 272 W FAIRVIEW AVE
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City | SAN GABRIEL
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State | CA
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Zip | 91776-2943
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Country | US
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Telephone | 626-872-6868
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Fax | 626-782-7778
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Provider Business Mailing Address
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Address Line | 272 W FAIRVIEW AVE
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City | SAN GABRIEL
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State | CA
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Zip | 91776-2943
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Country | US
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Telephone | 626-872-6868
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Fax | 626-782-7778
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Authorized Official
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Title or Position | PRESIDENT
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Name | OJIN KWON
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Credential | D.D.S.
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Telephone | 626-222-0730
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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 |
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License Number State |
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