Provider Demographics
NPI:1154878999
Name:KWOK CHEN AND KIM DENTAL GROUP
Entity type:Organization
Organization Name:KWOK CHEN AND KIM DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWERN/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:KWOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-799-1258
Mailing Address - Street 1:1928 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4874
Mailing Address - Country:US
Mailing Address - Phone:626-799-1252
Mailing Address - Fax:
Practice Address - Street 1:1928 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4874
Practice Address - Country:US
Practice Address - Phone:626-799-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty