Provider Demographics
NPI:1992549505
Name:IRVINE KID'S DENTIST
Entity type:Organization
Organization Name:IRVINE KID'S DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-653-2828
Mailing Address - Street 1:4980 BARRANCA PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8654
Mailing Address - Country:US
Mailing Address - Phone:949-653-2828
Mailing Address - Fax:
Practice Address - Street 1:4980 BARRANCA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8654
Practice Address - Country:US
Practice Address - Phone:949-653-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty