Provider Demographics
NPI:1871761361
Name:TEO, KYON MAUNG (DDS)
Entity type:Individual
Prefix:
First Name:KYON
Middle Name:MAUNG
Last Name:TEO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E HATCH RD STE H
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-5080
Mailing Address - Country:US
Mailing Address - Phone:209-556-9999
Mailing Address - Fax:209-556-0188
Practice Address - Street 1:1633 E HATCH RD STE H
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-5080
Practice Address - Country:US
Practice Address - Phone:209-556-9999
Practice Address - Fax:209-556-0188
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist