| NPI | 1417512278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TUONGTHUY PHU HA Owner 213-248-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-05-07 |