| California Dental Group | |
|
12309 Carson St Hawaiian Gardens CA 90716-1603 | |
| (562) 403-8818 | |
| (562) 403-1024 |
| Full Name | California Dental Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 12309 Carson St, Hawaiian Gardens, California |
| Authorized Official Name and Position | Kwang Seob Kim (DENTIST) |
| Authorized Official Contact | 5624038818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| California Dental Group 12309 Carson St Hawaiian Gardens CA 90716-1603 Ph: (562) 403-8818 | California Dental Group 12309 Carson St Hawaiian Gardens CA 90716-1603 Ph: (562) 403-8818 |
| NPI Number | 1851863393 |
|---|---|
| Provider Enumeration Date | 12/21/2018 |
| Last Update Date | 06/24/2019 |
| Medicare PECOS PAC ID | 7810221983 |
|---|---|
| Medicare Enrollment ID | O20190624000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851863393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Kwang Seob Kim |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1003035114 PECOS PAC ID: 7810221934 Enrollment ID: I20190624002964 |
Newport Dental - Hawaiian Gardens Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 21714 Pioneer Blvd, Hawaiian Gardens, CA 90716 Phone: 562-421-3737 | |
Sahawneh Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 21714 Pioneer Blvd, Hawaiian Gardens, CA 90716 Phone: 562-421-3737 | |
Hyun Chan Lee Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12137 E Carson St, Hawaiian Gardens, CA 90716 Phone: 562-402-8060 Fax: 562-809-1552 | |
Newport Dental Hawaiian Gardens Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 21714 Pioneer Blvd, Hawaiian Gardens, CA 90716 Phone: 562-421-3737 | |
Young Rae Kim, Dds Inc Dental Clinic Medicare: Medicare Enrolled Practice Location: 12144 E. Carson Street, Suite E, Hawaiian Gardens, CA 90716 Phone: 562-982-1380 Fax: 562-982-1383 | |
Keun Chan Lee Dds Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12531 Carson St, Hawaiian Gardens, CA 90716 Phone: 562-924-2448 Fax: 562-402-7587 |