Provider Demographics
NPI:1235394750
Name:KINGSTON DENTAL CORP.
Entity Type:Organization
Organization Name:KINGSTON DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-540-6248
Mailing Address - Street 1:21350 HAWTHORNE BLVD STE 151
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5672
Mailing Address - Country:US
Mailing Address - Phone:310-540-6248
Mailing Address - Fax:310-540-6258
Practice Address - Street 1:21350 HAWTHORNE BLVD STE 151
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5672
Practice Address - Country:US
Practice Address - Phone:310-540-6248
Practice Address - Fax:310-540-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty