| NPI | 1811214356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC THOMAS WONG President 310-259-2114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 58395) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2011-05-06 |