Provider Demographics
NPI:1760815120
Name:THE DENTAL CORPORATION OF KYAW KYAW MG, DDS, INC.
Entity Type:Organization
Organization Name:THE DENTAL CORPORATION OF KYAW KYAW MG, DDS, INC.
Other - Org Name:POLAR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KYAW
Authorized Official - Middle Name:KYAW
Authorized Official - Last Name:MG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-575-1191
Mailing Address - Street 1:11004 LOWER AZUSA RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1440
Mailing Address - Country:US
Mailing Address - Phone:626-575-1191
Mailing Address - Fax:626-575-3977
Practice Address - Street 1:11004 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1440
Practice Address - Country:US
Practice Address - Phone:626-575-1191
Practice Address - Fax:626-575-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9351501Medicaid