| NPI | 1326504366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERISSA CHONG Owner 408-805-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2019-02-14 |