| |
5480 Beach Blvd Buena Park CA 90621-1234 | |
(714) 739-5000 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 5480 Beach Blvd, Buena Park, California |
Authorized Official Name and Position | Sunki Rhee (PRESIDENT) |
Authorized Official Contact | 3104153909 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5480 Beach Blvd Buena Park CA 90621-1234 Ph: (714) 739-5000 | 5480 Beach Blvd Buena Park CA 90621-1234 Ph: (714) 739-5000 |
NPI Number | 1902052194 |
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Provider Enumeration Date | 08/07/2008 |
Last Update Date | 08/07/2008 |
Medicare PECOS PAC ID | 8224350020 |
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Medicare Enrollment ID | O20141205001083 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902052194 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | 52678 (California) | Primary |
Provider Name | Sunki Rhee |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1881893634 PECOS PAC ID: 4981926888 Enrollment ID: I20141204000008 |
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