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5661 Beach Blvd Ste 100 Buena Park CA 90621-1969 | |
| (714) 994-2121 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5661 Beach Blvd Ste 100, Buena Park, California |
| Authorized Official Name and Position | Hannah Jiyoung Song (PEDIATRIC DENTIST/ C.F.O.) |
| Authorized Official Contact | 7149942121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5661 Beach Blvd Ste 100 Buena Park CA 90621-1969 Ph: (714) 994-2121 | 5661 Beach Blvd Ste 100 Buena Park CA 90621-1969 Ph: (714) 994-2121 |
| NPI Number | 1619215175 |
|---|---|
| Provider Enumeration Date | 01/17/2013 |
| Last Update Date | 01/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619215175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 58464 (California) | Primary |
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