Provider Demographics
NPI:1225240757
Name:KWONG, ARDEN LON (DDS)
Entity type:Individual
Prefix:DR
First Name:ARDEN
Middle Name:LON
Last Name:KWONG
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 1:2430 L ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5007
Mailing Address - Country:US
Mailing Address - Phone:916-441-1057
Mailing Address - Fax:916-441-3561
Practice Address - Street 1:2430 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5007
Practice Address - Country:US
Practice Address - Phone:916-441-1057
Practice Address - Fax:916-441-3561
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31819OtherSTATEBOARDDENTALLICENSE