Justin J Kwon DDS, P.C.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

JUSTIN J KWON DDS, P.C.

Practice address

290 Nickel St Ste 500
Broomfield, CO 80020-2129

Phone

(303) 469-5301

NPI assigned

Oct 23, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Kwon, DDS

Title

Owner

Phone

(303) 469-5301

Specialties & licenses 2

Addresses

Other names 1

• GREEN DENTAL Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1366918757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 NICKEL ST STE 500",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 NICKEL ST STE 500",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202129",
            "telephone_number": "303-469-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN J KWON DDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-11-13",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-469-5301",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREEN DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.