Provider Demographics
NPI:1346568375
Name:KWAK, ELBERT KYEUNG-HO (DDS)
Entity Type:Individual
Prefix:
First Name:ELBERT
Middle Name:KYEUNG-HO
Last Name:KWAK
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 1:1000 BAY AREA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1404
Mailing Address - Country:US
Mailing Address - Phone:281-990-9400
Mailing Address - Fax:
Practice Address - Street 1:1000 BAY AREA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1404
Practice Address - Country:US
Practice Address - Phone:281-990-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253591223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice