| NPI | 1437406873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MIEUN PARK-LEE Owner/Partner 909-888-5499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 40976) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 36091) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |