| Ucla Venice Clinical | |
|
323 Lincoln Blvd Venice CA 90291-2842 | |
| (310) 392-4103 | |
| (310) 392-8513 |
| Full Name | Ucla Venice Clinical |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 323 Lincoln Blvd, Venice, California |
| Authorized Official Name and Position | John Yamamanto (CLENAL DIRECTOR) |
| Authorized Official Contact | 3103924103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ucla Venice Clinical 323 Lincoln Blvd Venice CA 90291-2842 Ph: (310) 392-4103 | Ucla Venice Clinical 323 Lincoln Blvd Venice CA 90291-2842 Ph: (310) 392-4103 |
| NPI Number | 1932253184 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932253184 | NPI | - | NPPES |
| UO1004 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D40407 (California) | Primary |
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