MEDICARE: CHHINA DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	3799799	CA

General Provider Information

NPI Number	:	1013390483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHHINA DENTAL GROUP

Provider Business Mailing Address
First Line	:	1310 TARA HILLS DR STE F
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2533
Country	:	US
Telephone Number	:	510-724-6900
Fax Number	:	510-724-2707

Provider Business Practice Location Address
First Line	:	1310 TARA HILLS DR STE F
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2533
Country	:	US
Telephone Number	:	510-724-6900
Fax Number	:	510-724-2707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MUNDEEP SINGH CHHINA
Credential	:	DDS
Telephone Number	:	310-721-4457

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	07/03/2015

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