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2200 Harbor Blvd Ste B230 Costa Mesa CA 92627 | |
| (949) 646-1650 | |
| (949) 646-1576 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2200 Harbor Blvd, Costa Mesa, California |
| Authorized Official Name and Position | Anthony Hung Cao (PRESIDENT OWNER) |
| Authorized Official Contact | 9496461650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2200 Harbor Blvd Ste B230 Costa Mesa CA 92627 Ph: (949) 646-1650 | 2200 Harbor Blvd Ste B230 Costa Mesa CA 92627 Ph: (949) 646-1650 |
| NPI Number | 1164514220 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 08/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164514220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 43909 (California) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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