Facts
- Status
- A
- Credential
- D.D.S.
- Type
- Individual
- Enumeration date
- 2007-03-26
- Last updated
- 2007-07-08
Specialties
Licenses
- License CA
- 28649
Location
- Practice location
- 18276 IMPERIAL HWY
- City
- YORBA LINDA CA
- Postal code
- 928863472
- Phone
- 714-993-7910
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.