Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 48305 | CA |
NPI | 1104862051 |
---|---|
Provider Name | Dr. Jane Kwon |
First Address | North Hills, CA 91343-2036 |
Second Address | North Hills, CA 91343-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 27/03/2014 |