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11458 Kenyon Way Suite 120 Rancho Cucamonga CA 91701-9219 | |
(909) 941-2811 | |
(909) 941-7271 |
Full Name | |
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Speciality | Dentist |
Location | 11458 Kenyon Way, Rancho Cucamonga, California |
Authorized Official Name and Position | Brien Hsu (OWNER) |
Authorized Official Contact | 9099412811 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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11458 Kenyon Way Suite 120 Rancho Cucamonga CA 91701-9219 Ph: (909) 941-2811 | 11458 Kenyon Way Suite 120 Rancho Cucamonga CA 91701-9219 Ph: (909) 941-2811 |
NPI Number | 1174915664 |
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Provider Enumeration Date | 02/20/2015 |
Last Update Date | 02/20/2015 |
Medicare PECOS PAC ID | 7214242510 |
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Medicare Enrollment ID | O20150815000018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174915664 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 47485 (California) | Primary |
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