Provider Demographics
NPI:1861641151
Name:KWONG, JEFFREY CHEE-FAI (DDS MSD BSC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHEE-FAI
Last Name:KWONG
Suffix:
Gender:M
Credentials:DDS MSD BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 ARDEN BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6021
Mailing Address - Country:US
Mailing Address - Phone:216-533-9391
Mailing Address - Fax:
Practice Address - Street 1:781 STERLING PKWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7320
Practice Address - Country:US
Practice Address - Phone:916-543-7880
Practice Address - Fax:916-543-7885
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics