Provider Demographics
NPI:1730673492
Name:JOW, BRIAN KENJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENJI
Last Name:JOW
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 1:1023 WIGET LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4310
Mailing Address - Country:US
Mailing Address - Phone:925-451-7501
Mailing Address - Fax:
Practice Address - Street 1:2800 PACIFIC AVE STE B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1468
Practice Address - Country:US
Practice Address - Phone:562-989-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist