Provider Demographics
NPI:1861833113
Name:KWAKYE, CHARLES FRIMPONG (RDH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRIMPONG
Last Name:KWAKYE
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 RANWICK CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2042
Mailing Address - Country:US
Mailing Address - Phone:408-267-4970
Mailing Address - Fax:
Practice Address - Street 1:12121 WILSHIRE BLVD. SUITE1111
Practice Address - Street 2:WEST COAST DENTAL SERVICES
Practice Address - City:LOS ANGELES,
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-409-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19264124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist