Provider Demographics
NPI:1144494634
Name:CONWAY K. W. WOO, D.D.S., P.C.
Entity type:Organization
Organization Name:CONWAY K. W. WOO, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONWAY
Authorized Official - Middle Name:KW
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-439-8224
Mailing Address - Street 1:1201 E HERNDON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3238
Mailing Address - Country:US
Mailing Address - Phone:559-439-8224
Mailing Address - Fax:559-431-5097
Practice Address - Street 1:1201 E HERNDON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3238
Practice Address - Country:US
Practice Address - Phone:559-439-8224
Practice Address - Fax:559-431-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT07701Medicare UPIN