| NPI | 1194385609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JEONG Owner 718-762-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |