| K.sumardi Dds Inc. | |
|
1965 Foothill Blvd Ste L La Verne CA 91750-3502 | |
| (909) 596-6500 | |
| (909) 596-8809 |
| Full Name | K.sumardi Dds Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1965 Foothill Blvd Ste L, La Verne, California |
| Authorized Official Name and Position | Kusumo Sumardi (PRESIDENT) |
| Authorized Official Contact | 9095966500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| K.sumardi Dds Inc. 1965 Foothill Blvd Ste L La Verne CA 91750-3502 Ph: (909) 596-6500 | K.sumardi Dds Inc. 1965 Foothill Blvd Ste L La Verne CA 91750-3502 Ph: (909) 596-6500 |
| NPI Number | 1942603105 |
|---|---|
| Provider Enumeration Date | 10/02/2014 |
| Last Update Date | 10/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942603105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 41680 (California) | Primary |
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