Provider Demographics
NPI:1255454690
Name:PHILLIP Z KAW DENTAL CORPORATION
Entity type:Organization
Organization Name:PHILLIP Z KAW DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-288-2886
Mailing Address - Street 1:7551 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2911
Mailing Address - Country:US
Mailing Address - Phone:626-288-2886
Mailing Address - Fax:
Practice Address - Street 1:7551 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2911
Practice Address - Country:US
Practice Address - Phone:626-288-2886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB40627-021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty