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3811 Bedford Canyon Rd Ste 105 Corona CA 92883-0789 | |
| (951) 270-0211 | |
| (951) 270-0702 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3811 Bedford Canyon Rd Ste 105, Corona, California |
| Authorized Official Name and Position | Pauline Pham Wong (PRESIDENT) |
| Authorized Official Contact | 9512700211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 27250 Anaheim CA 92809-0297 Ph: (951) 270-0211 | 3811 Bedford Canyon Rd Ste 105 Corona CA 92883-0789 Ph: (951) 270-0211 |
| NPI Number | 1417128034 |
|---|---|
| Provider Enumeration Date | 03/24/2008 |
| Last Update Date | 03/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417128034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 53643 (California) | Primary |
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