Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 60677153 | WA |
N | 1223X0400X | Orthodontists | 60677153 | WA |
Y | 1223X0400X | Orthodontists | S3-355C | NV |
NPI | 1043763824 |
---|---|
Provider Name | Camy Kwok |
First Address | Las Vegas, NV 89129-6018 |
Second Address | Las Vegas, NV 89129-6018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60677153 | DENTIST (01) | WA |
S3-355C | DENTIST (01) | NV |