| NPI | 1679790638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOUROSH MICHAEL BERAL President 310-666-5453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 46749) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2016-08-22 |