Provider Demographics
NPI:1801397369
Name:DR KWAK YONSEI DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR KWAK YONSEI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYOUNG
Authorized Official - Middle Name:WHAN
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-731-0707
Mailing Address - Street 1:981 S WESTERN AVE STE 200A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1080
Mailing Address - Country:US
Mailing Address - Phone:323-731-0707
Mailing Address - Fax:
Practice Address - Street 1:981 S WESTERN AVE STE 200A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1080
Practice Address - Country:US
Practice Address - Phone:323-731-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty