| NPI | 1164897351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERLENE TING Administrator 626-375-0656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2020-12-09 |