| NPI | 1003384579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANN BOONNARAGORN Office Manager 213-270-3235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |