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1401 S Brookhurst Rd Ste 104 Fullerton CA 92833-4492 | |
| (714) 879-2828 | |
| (714) 879-2226 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1401 S Brookhurst Rd Ste 104, Fullerton, California |
| Authorized Official Name and Position | Kevin La (PRESIDENT) |
| Authorized Official Contact | 7148792828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1401 S Brookhurst Rd Ste 104 Fullerton CA 92833-4492 Ph: (714) 879-2828 | 1401 S Brookhurst Rd Ste 104 Fullerton CA 92833-4492 Ph: (714) 879-2828 |
| NPI Number | 1053731166 |
|---|---|
| Provider Enumeration Date | 04/16/2014 |
| Last Update Date | 04/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053731166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 48734 (California) | Primary |
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Bom Jeon Dental Corp Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 S Brookhurst Rd Ste 104, Fullerton, CA 92833 Phone: 714-879-2828 | |
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