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1558 E H St Suite B Chula Vista CA 91913-2018 | |
| (619) 421-9070 | |
| (619) 421-9216 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1558 E H St, Chula Vista, California |
| Authorized Official Name and Position | Koroush Bassiri (CEO) |
| Authorized Official Contact | 6194219070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1558 E H St Suite B Chula Vista CA 91913-2018 Ph: (619) 421-9070 | 1558 E H St Suite B Chula Vista CA 91913-2018 Ph: (619) 421-9070 |
| NPI Number | 1366644221 |
|---|---|
| Provider Enumeration Date | 06/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366644221 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 43754 (California) | Primary |
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