| NPI | 1134518988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN A SIU Owner 661-259-2960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 29472) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 28618) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2015-01-16 |