| |
8536 Long Beach Blvd Suite B South Gate CA 90280-2017 | |
(323) 581-0754 | |
(323) 581-2106 |
Full Name | |
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Speciality | Dentist |
Location | 8536 Long Beach Blvd, South Gate, California |
Authorized Official Name and Position | Mehrdad Noori (OWNER) |
Authorized Official Contact | 3235810754 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8536 Long Beach Blvd Suite B South Gate CA 90280-2017 Ph: (323) 581-0754 | 8536 Long Beach Blvd Suite B South Gate CA 90280-2017 Ph: (323) 581-0754 |
NPI Number | 1922542356 |
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Provider Enumeration Date | 12/03/2016 |
Last Update Date | 12/03/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922542356 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 57118 (California) | Primary |
122300000X | Dentist | 58117 (California) | Secondary |
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