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4000 La Rica Ave Suite D Baldwin Park CA 91706-3163 | |
| (626) 430-9171 | |
| (626) 430-9177 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4000 La Rica Ave, Baldwin Park, California |
| Authorized Official Name and Position | Ryan Lee (OWNER) |
| Authorized Official Contact | 6264309171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4000 La Rica Ave Suite D Baldwin Park CA 91706-3163 Ph: (626) 430-9171 | 4000 La Rica Ave Suite D Baldwin Park CA 91706-3163 Ph: (626) 430-9171 |
| NPI Number | 1285858548 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285858548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 41594 (California) | Primary |
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