Provider Demographics
NPI:1952615130
Name:KWAK, EUNEJENE
Entity Type:Individual
Prefix:
First Name:EUNEJENE
Middle Name:
Last Name:KWAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:KWAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4536 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6200
Mailing Address - Country:US
Mailing Address - Phone:770-455-1238
Mailing Address - Fax:770-488-9550
Practice Address - Street 1:4536 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6200
Practice Address - Country:US
Practice Address - Phone:770-455-1238
Practice Address - Fax:770-488-9550
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant