| O.j Kwon Dental Corporation | |
|
9675 Monte Vista Ave Suite G Montclair CA 91763-2233 | |
| (909) 576-7175 | |
| Not Available |
| Full Name | O.j Kwon Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 9675 Monte Vista Ave, Montclair, California |
| Authorized Official Name and Position | Oh Jae Kwon (PRESIDENT) |
| Authorized Official Contact | 9095767175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| O.j Kwon Dental Corporation 9675 Monte Vista Ave Suite G Montclair CA 91763-2233 Ph: (909) 576-7175 | O.j Kwon Dental Corporation 9675 Monte Vista Ave Suite G Montclair CA 91763-2233 Ph: (909) 576-7175 |
| NPI Number | 1972044337 |
|---|---|
| Provider Enumeration Date | 03/17/2017 |
| Last Update Date | 03/17/2017 |
| Medicare PECOS PAC ID | 4082093562 |
|---|---|
| Medicare Enrollment ID | O20220614003014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972044337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 46484 (California) | Primary |
| Provider Name | Michael Yang |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1578035333 PECOS PAC ID: 4880073048 Enrollment ID: I20220617000506 |
| Provider Name | Oh J Kwon |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1972576866 PECOS PAC ID: 4688978570 Enrollment ID: I20220715000720 |
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