Provider Demographics
NPI:1982745634
Name:KWON, JUSTIN JIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:JIN
Last Name:KWON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E BETHANY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2680
Mailing Address - Country:US
Mailing Address - Phone:303-745-8828
Mailing Address - Fax:720-748-8867
Practice Address - Street 1:10700 E BETHANY DR STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2680
Practice Address - Country:US
Practice Address - Phone:303-745-8828
Practice Address - Fax:720-748-8867
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9361701OtherDENTI CAL