Provider Demographics
NPI:1720322449
Name:KWON DENTAL CORPORATION
Entity Type:Organization
Organization Name:KWON DENTAL CORPORATION
Other - Org Name:ALESSANDRO DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OH JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-322-4060
Mailing Address - Street 1:13925 INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5718
Mailing Address - Country:US
Mailing Address - Phone:951-322-4060
Mailing Address - Fax:951-322-4061
Practice Address - Street 1:13925 INDIAN ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5718
Practice Address - Country:US
Practice Address - Phone:951-322-4060
Practice Address - Fax:951-322-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty