Provider Demographics
NPI:1003834003
Name:KWON, VIVIAN OKHEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:OKHEE
Last Name:KWON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6341
Mailing Address - Country:US
Mailing Address - Phone:909-335-2913
Mailing Address - Fax:
Practice Address - Street 1:2955 VAN BUREN BLVD
Practice Address - Street 2:STE H4
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5674
Practice Address - Country:US
Practice Address - Phone:951-689-8544
Practice Address - Fax:951-689-2465
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice