| NPI | 1578961256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK WONG President 213-820-0351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 58157) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2014-12-12 |