Basic Information
| Provider Information | |||||||||
| NPI: | 1366706699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUI | ||||||||
| FirstName: | KENNETH KWUN-KIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5716 MICHIGAN AVE | ||||||||
| Address2: | SUITE 1100 - COVENANT COMMUNITY CARE INC | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482103039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135543880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5716 MICHIGAN AVE | ||||||||
| Address2: | SUITE 1100 - COVENANT COMMUNITY CARE INC | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482103039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135543880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901020522 | MI | Y | Dental Providers | Dentist |
No ID Information.