Provider Demographics
NPI:1417497736
Name:KWOK, VIVIEN
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:
Last Name:KWOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OLD FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M5P2P8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301-3601 HWY 7 E
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:ONTARIO
Practice Address - Zip Code:L3R0M3
Practice Address - Country:CA
Practice Address - Phone:647-283-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0589681223P0300X
ZZ524021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics