Provider Demographics
NPI:1336510528
Name:VIVIAN KWON D.D.S. INC.
Entity Type:Organization
Organization Name:VIVIAN KWON D.D.S. INC.
Other - Org Name:VIVIAN KWON D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-689-8544
Mailing Address - Street 1:2955 VAN BUREN BLVD
Mailing Address - Street 2:SUITE H4
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5674
Mailing Address - Country:US
Mailing Address - Phone:951-689-8544
Mailing Address - Fax:951-689-2465
Practice Address - Street 1:2955 VAN BUREN BLVD
Practice Address - Street 2:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA434521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty