Provider Demographics
NPI:1013553478
Name:PAUL Y KWON, DDS, PLLC
Entity Type:Organization
Organization Name:PAUL Y KWON, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-787-1507
Mailing Address - Street 1:746 F ST SW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1370
Mailing Address - Country:US
Mailing Address - Phone:509-787-1507
Mailing Address - Fax:509-787-2100
Practice Address - Street 1:746 F ST SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1370
Practice Address - Country:US
Practice Address - Phone:509-787-1507
Practice Address - Fax:509-787-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty