Provider Demographics
NPI:1225292774
Name:KWON, SANG HOYK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:HOYK
Last Name:KWON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W 86TH ST
Mailing Address - Street 2:118
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1411
Mailing Address - Country:US
Mailing Address - Phone:317-872-4746
Mailing Address - Fax:317-663-1169
Practice Address - Street 1:6010 W 86TH ST
Practice Address - Street 2:118
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1411
Practice Address - Country:US
Practice Address - Phone:317-872-4746
Practice Address - Fax:317-663-1169
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011161A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice