| NPI | 1023598836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HASSAN FAYOUMI CEO 310-699-1549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 52604) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CA 50718) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |