| NPI | 1215136304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER C LEE Secretatry 626-288-0080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 59163) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51945) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2010-01-16 |