| NPI | 1225132483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUCK T LE President 714-491-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 37342) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 44850) |
| 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: CA 41940) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 49591) | |
| 1223P0300X Dentist Periodontics (Licence: CA 34587) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 19083) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2021-05-14 |