Basic Information
| Provider Information | |||||||||
| NPI: | 1275186264 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | K FAMILY DENTISTRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 GRAND AVENUE PARKWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PFLUGERVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126492828 | ||||||||
| FaxNumber: | 5126492853 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 GRAND AVENUE PARKWAY | ||||||||
| Address2: | SUITE150 | ||||||||
| City: | PFLUGERVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162255969 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2019 | ||||||||
| LastUpdateDate: | 12/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DMD/ DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 5126492828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/18/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.