Provider Demographics
NPI:1962782011
Name:KWAN, KEVIN CHINGLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHINGLIN
Last Name:KWAN
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 1:6552 BOLSA AVE
Mailing Address - Street 2:SUITE # F
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2660
Mailing Address - Country:US
Mailing Address - Phone:714-893-8517
Mailing Address - Fax:
Practice Address - Street 1:6552 BOLSA AVE
Practice Address - Street 2:SUITE # F
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2660
Practice Address - Country:US
Practice Address - Phone:714-893-8517
Practice Address - Fax:714-893-0788
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist