| NPI | 1316435514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE AHN WALLACE President 714-230-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261Q00000X |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2018-04-24 |