Provider Demographics
NPI:1346858677
Name:KIDS DENTAL OF QUEENS PC
Entity Type:Organization
Organization Name:KIDS DENTAL OF QUEENS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-396-4700
Mailing Address - Street 1:4236 82ND ST # C
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3537
Mailing Address - Country:US
Mailing Address - Phone:917-396-4700
Mailing Address - Fax:
Practice Address - Street 1:4236 82ND ST # C
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3537
Practice Address - Country:US
Practice Address - Phone:917-396-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty