Provider Demographics
NPI:1417054529
Name:KWON, ROBIN Y (DDS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:Y
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 1:1201 SE 223RD AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2580
Mailing Address - Country:US
Mailing Address - Phone:503-661-2828
Mailing Address - Fax:503-618-9874
Practice Address - Street 1:1201 SE 223RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-661-2828
Practice Address - Fax:503-618-9874
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice