| Mead Valley Community Dental Clinic | |
|
21091 Rider St Suite 203 Perris CA 92570-8878 | |
| (951) 322-4058 | |
| Not Available |
| Full Name | Mead Valley Community Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 21091 Rider St, Perris, California |
| Authorized Official Name and Position | Oh Jae Kwon (PRESIDENT) |
| Authorized Official Contact | 9513224058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mead Valley Community Dental Clinic 21091 Rider St Suite 203 Perris CA 92570-8878 Ph: (951) 322-4058 | Mead Valley Community Dental Clinic 21091 Rider St Suite 203 Perris CA 92570-8878 Ph: (951) 322-4058 |
| NPI Number | 1881021434 |
|---|---|
| Provider Enumeration Date | 09/27/2013 |
| Last Update Date | 02/10/2017 |
| Medicare PECOS PAC ID | 5698159283 |
|---|---|
| Medicare Enrollment ID | O20220831001246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881021434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 46484 (California) | Primary |
| Provider Name | Oh J Kwon |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1972576866 PECOS PAC ID: 4688978570 Enrollment ID: I20220715000720 |
| Provider Name | Alex J Wong |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1457881575 PECOS PAC ID: 5799169652 Enrollment ID: I20220826001999 |
| Provider Name | Su Mei Mai |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1487179743 PECOS PAC ID: 8224412796 Enrollment ID: I20220901000522 |
| Provider Name | Chad D Aloisio |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467510487 PECOS PAC ID: 8022314699 Enrollment ID: I20220913001798 |
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