| Andre Widodo Dds A Professional Corporation | |
|
11635 Valley Blvd Ste E El Monte CA 91732-3071 | |
| (626) 444-7645 | |
| (626) 444-7628 |
| Full Name | Andre Widodo Dds A Professional Corporation |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11635 Valley Blvd Ste E, El Monte, California |
| Authorized Official Name and Position | Andre Widodo (DENTIST / OWNER) |
| Authorized Official Contact | 6264447645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Andre Widodo Dds A Professional Corporation 11635 Valley Blvd Ste E El Monte CA 91732-3071 Ph: (626) 444-7645 | Andre Widodo Dds A Professional Corporation 11635 Valley Blvd Ste E El Monte CA 91732-3071 Ph: (626) 444-7645 |
| NPI Number | 1447583661 |
|---|---|
| Provider Enumeration Date | 09/08/2009 |
| Last Update Date | 09/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447583661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 46152 (California) | Primary |
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Wan Yi Chu & Chao Kuei Chen Dds Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10990 Lower Azusa Rd, #6, El Monte, CA 91731 Phone: 626-448-4288 Fax: 626-448-1978 | |
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