| NPI | 1841430345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAO-THY N GRANT Officer 310-408-8221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 52655) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |