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15401 Hesperian Blvd Suite F San Leandro CA 94578-3973 | |
| (510) 317-9439 | |
| (510) 317-9558 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15401 Hesperian Blvd, San Leandro, California |
| Authorized Official Name and Position | Jorn Natanauan Olimpiada (OWNER) |
| Authorized Official Contact | 5103179439 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15401 Hesperian Blvd Suite F San Leandro CA 94578-3973 Ph: (510) 317-9439 | 15401 Hesperian Blvd Suite F San Leandro CA 94578-3973 Ph: (510) 317-9439 |
| NPI Number | 1124198619 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124198619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 47542 (California) | Primary |
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