| Su Mei Mai, | |
|
3745 Fredricksburg St Apt B, Fort Irwin, CA 92310-1701 | |
| (270) 798-8751 | |
| Not Available |
| Full Name | Su Mei Mai |
|---|---|
| Gender | Female |
| Speciality | Dentist |
| Location | 3745 Fredricksburg St Apt B, Fort Irwin, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487179743 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 101839 (California) | Primary |
| Entity Name | Kwon Dds Professional Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1881021434 PECOS PAC ID: 5698159283 Enrollment ID: O20220831001246 |
| Mailing Address | Practice Location Address |
|---|---|
| Su Mei Mai, 3745 Fredricksburg St Apt B, Fort Irwin, CA 92310-1701 Ph: (270) 798-8751 | Su Mei Mai, 3745 Fredricksburg St Apt B, Fort Irwin, CA 92310-1701 Ph: (270) 798-8751 |
Dr. Stephanie Chung Lee, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 171 Inner Loop Road, Fort Irwin, CA 92310 Phone: 760-380-3166 | |
Ryan Steven Payne, Dentist Medicare: Not Enrolled in Medicare Practice Location: 4th & Inner Loop Road, Bldg 171, Fort Irwin, CA 92310 Phone: 719-526-5537 Fax: 706-787-2082 | |
Dr. Joshua Hyungkyu Lee, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 4th And Inner Loop Road, Bldg 171, Fort Irwin, CA 92310 Phone: 719-526-5537 | |
Dr. Yong Soo Kim, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 171 Inner Loop Rd, Fort Irwin, CA 92310 Phone: 760-380-3166 | |
Dustin Tyler Nygard, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: Bldg, 390 N Loop Rd, Fort Irwin, CA 92310 Phone: 760-380-3166 | |
Dr. Sergio Hernandez, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 171 Inner Loop Rd, Fort Irwin, CA 92310 Phone: 760-380-3173 | |
Dr. Dolores Luque, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: Building 171, 4th & Inner Loop Rd, Fort Irwin, CA 92310 Phone: 760-380-5733 Fax: 760-380-4996 |