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13768 Roswell Ave Ste 210 Chino CA 91710-1407 | |
| (909) 591-1055 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 13768 Roswell Ave Ste 210, Chino, California |
| Authorized Official Name and Position | Jack T Yu (OWNER) |
| Authorized Official Contact | 9095911055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13768 Roswell Ave Ste 210 Chino CA 91710-1407 Ph: (909) 591-1055 | 13768 Roswell Ave Ste 210 Chino CA 91710-1407 Ph: (909) 591-1055 |
| NPI Number | 1144723107 |
|---|---|
| Provider Enumeration Date | 03/15/2018 |
| Last Update Date | 04/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144723107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 48412 (California) | Primary |
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