Active NPI
Kwon DDS Professional Corporation
Doing business as Mead Valley Community Dental Clinic
- Dentist
- Perris, CA
National Provider Identifier
1881021434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 46484
- Legal business name
- KWON DDS PROFESSIONAL CORPORATION
- Doing business as
- Mead Valley Community Dental Clinic
- Practice address
- 21091 Rider St
Suite 203
Perris, CA 92570-8878 - Phone
- (951) 322-4058
- NPI assigned
- Sep 27, 2013
- Last updated
- Feb 10, 2017
- Organization subpart
- Yes
- Parent organization
- KWON DDS PROFESSIONAL CORPORATION
NPPES NPI Registry
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
- (951) 322-4058
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 46484 | CA | Primary |
Addresses
Primary practice location
21091 Rider St
Suite 203
Perris, CA 92570-8878
Mailing address
21091 Rider St
Suite 203
Perris, CA 92570-8878
Phone (951) 322-4058
Other names 1
- Mead Valley Community Dental Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Part of
- Kwon DDS Professional Corporation
Locations
21091 Rider St
Ste 203
Perris, CA 92570
Phone (951) 322-4058
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Dentist
- Los Angeles, CA
- NPI 1467510487
-
- Dentist
- Riverside, CA
- NPI 1972576866
-
- Dentist
- Fort Irwin, CA
- NPI 1487179743
-
- Dentist
- Oakland, CA
- NPI 1457881575
-
- Dentist
- Perris, CA
- NPI 1174931661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380240000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1486684800000",
"number": "1881021434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21091 RIDER ST",
"address_2": "SUITE 203",
"city": "PERRIS",
"state": "CA",
"postal_code": "925708878",
"telephone_number": "951-322-4058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21091 RIDER ST",
"address_2": "SUITE 203",
"city": "PERRIS",
"state": "CA",
"postal_code": "925708878",
"telephone_number": "951-322-4058"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KWON DDS PROFESSIONAL CORPORATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "KWON DDS PROFESSIONAL CORPORATION",
"enumeration_date": "2013-09-27",
"last_updated": "2017-02-10",
"status": "A",
"authorized_official_last_name": "KWON",
"authorized_official_first_name": "OH JAE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "951-322-4058",
"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": "Mead Valley Community Dental Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Perris, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.