Provider Demographics
NPI:1730802752
Name:TAE WOO KWON, DDS, INC
Entity type:Organization
Organization Name:TAE WOO KWON, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAE WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-890-0816
Mailing Address - Street 1:7429 N 1ST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2852
Mailing Address - Country:US
Mailing Address - Phone:559-448-9870
Mailing Address - Fax:
Practice Address - Street 1:3400 MCCALL AVE STE 118
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2560
Practice Address - Country:US
Practice Address - Phone:559-896-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty