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NPI Code Detail

MEDICARE: OJ KWON DDS, INC

MEDICARE: OJ KWON DDS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist46484CA

General Provider Information

NPI Number : 1881741429
Entity Type Code : Organization
Provider Name (Legal Business Name) : OJ KWON DDS, INC
Provider Business Mailing Address
First Line : 9939 MAGNOLIA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3528
Country : US
Telephone Number : 951-588-5600
Fax Number : 951-588-5603
Provider Business Practice Location Address
First Line : 9939 MAGNOLIA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3528
Country : US
Telephone Number : 951-588-5600
Fax Number : 951-588-5603
Authorized Official
Title or Position : PRESIDENT
Name : DR. OH JAE KWON
Credential : DDS
Telephone Number : 951-588-5600
Provider Enumeration Date : 01/05/2007
Last Update Date : 03/31/2017

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Directions to “OJ KWON DDS, INC ” Practice Location

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