Provider Demographics
NPI:1356753545
Name:KWON ORTHODONTICS
Entity type:Organization
Organization Name:KWON ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOONG
Authorized Official - Middle Name:GUN
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-739-8678
Mailing Address - Street 1:3700 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2901
Mailing Address - Country:US
Mailing Address - Phone:213-739-8678
Mailing Address - Fax:
Practice Address - Street 1:3700 WILSHIRE BLVD
Practice Address - Street 2:SUITE #400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2901
Practice Address - Country:US
Practice Address - Phone:213-739-8678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty