| NPI | 1699177642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY LEETRAKUL President 818-765-3534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58017) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2021-06-02 |