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1501 Superior Ave Suite 200 Newport Beach CA 92663-3600 | |
| (949) 642-9928 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1501 Superior Ave, Newport Beach, California |
| Authorized Official Name and Position | Johnny Wong (PRESIDENT) |
| Authorized Official Contact | 9496429928 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1501 Superior Ave Suite 200 Newport Beach CA 92663-3600 Ph: (949) 642-9928 | 1501 Superior Ave Suite 200 Newport Beach CA 92663-3600 Ph: (949) 642-9928 |
| NPI Number | 1184894602 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 03/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184894602 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 55752 (California) | Primary |
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