| NPI | 1164110151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JINO PARK Owner 909-969-3503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2023-08-31 |