Oh Jae Kwon, DDS, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

46484 Issued in CA

Legal business name

OH JAE KWON, DDS, INC

Doing business as

Elsinore Main Street Dental

Practice address

141 N Main St
Lake Elsinore, CA 92530-4118

Phone

(951) 245-5003

Fax

(951) 471-0637

NPI assigned

May 4, 2011

Last updated

Jul 6, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Oh Jae Kwon, DDS

Title

President

Phone

(909) 576-7175

Specialties & licenses 1

Addresses

Other names 1

• Elsinore Main Street Dental Doing business as

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1740572197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 N MAIN ST",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304118",
            "telephone_number": "951-245-5003",
            "fax_number": "951-471-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 N MAIN ST",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304118",
            "telephone_number": "951-245-5003",
            "fax_number": "951-471-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OH JAE KWON, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "OH JAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-576-7175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "46484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elsinore Main Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nathan Ocasio, COTA/L
• Edith Ochoa Bautista
• Lucas Odahlen, D.C.
• Michelle Oei, PHARM.D.
• Jeanna Marie Ogle
• Alyssa Mahealani Ohara
• Oliveira Medical Inc
• Thomas Edward Oliveira, D.O.
• Donald Olson
• Timothy M Olson, MFT

• Dentist in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; 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.