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3120 S Hacienda Blvd Ste 204 Hacienda Heights CA 91745-6305 | |
| (239) 938-6860 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3120 S Hacienda Blvd Ste 204, Hacienda Heights, California |
| Authorized Official Name and Position | Jea Young Jeon (CEO) |
| Authorized Official Contact | 6263304548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3120 S Hacienda Blvd Ste 204 Hacienda Heights CA 91745-6305 Ph: (626) 330-4548 | 3120 S Hacienda Blvd Ste 204 Hacienda Heights CA 91745-6305 Ph: (239) 938-6860 |
| NPI Number | 1104579465 |
|---|---|
| Provider Enumeration Date | 01/27/2022 |
| Last Update Date | 03/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104579465 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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