| NPI | 1508105255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDY HOANG Owner 951-699-3250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2020-09-22 |