| NPI | 1104034982 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | JONATHAN CHUONG LE NGUYEN Dentist 619-281-5569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 51099) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2015-11-02 |