Provider Demographics
NPI:1558683649
Name:HENRY S. KWON, D.D.S. INC.
Entity Type:Organization
Organization Name:HENRY S. KWON, D.D.S. INC.
Other - Org Name:CARE FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-820-9454
Mailing Address - Street 1:2836 W RIALTO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6816
Mailing Address - Country:US
Mailing Address - Phone:909-820-9454
Mailing Address - Fax:909-820-9482
Practice Address - Street 1:2836 W RIALTO AVE STE A
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6816
Practice Address - Country:US
Practice Address - Phone:909-820-9454
Practice Address - Fax:909-820-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD47505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4750501OtherDENTI-CAL