Provider Demographics
NPI:1215998562
Name:YVONNE KWONG DMD PA
Entity type:Organization
Organization Name:YVONNE KWONG DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:YUEN
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-321-8144
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:#502
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-321-8144
Mailing Address - Fax:410-296-2790
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:#502
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-321-8144
Practice Address - Fax:410-296-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty