| Ucla Maxillofacial Prosthetics | |
|
10833 Le Conte Ave Rm Ao-156a Chs Box 951668 Los Angeles CA 90095-3075 | |
| (310) 825-6510 | |
| (310) 206-4201 |
| Full Name | Ucla Maxillofacial Prosthetics |
|---|---|
| Speciality | Dentist |
| Location | 10833 Le Conte Ave Rm Ao-156a Chs, Los Angeles, California |
| Authorized Official Name and Position | Eric C Sung (DIRECTOR) |
| Authorized Official Contact | 3102066407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ucla Maxillofacial Prosthetics 10833 Le Conte Ave Rm Ao-156a Box 951668 Los Angeles CA 90095-3075 Ph: (310) 825-6510 | Ucla Maxillofacial Prosthetics 10833 Le Conte Ave Rm Ao-156a Chs Box 951668 Los Angeles CA 90095-3075 Ph: (310) 825-6510 |
| NPI Number | 1285771378 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 12/12/2014 |
| Medicare PECOS PAC ID | 1658696216 |
|---|---|
| Medicare Enrollment ID | O20150203000809 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285771378 | NPI | - | NPPES |
| G91297 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 38370 (California) | Primary |
| Provider Name | John E Beumer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1184836702 PECOS PAC ID: 0244309474 Enrollment ID: I20080514000537 |
| Provider Name | Eric C Sung |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1629161351 PECOS PAC ID: 2163747726 Enrollment ID: I20150305000367 |
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