| NPI | 1619468832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERLENE TING Administrator 626-375-0656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 52741) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 50018) |
| 1223P0300X Dentist, Periodontics (Licence: CA 51138) | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2024-05-31 |