MEDICARE: BARDI-PAK DENTAL CORPORATION

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1538998208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARDI-PAK DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	600 W BEVERLY BLVD STE B
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3660
Country	:	US
Telephone Number	:	323-721-9777
Fax Number	:	323-721-9787

Provider Business Practice Location Address
First Line	:	600 W BEVERLY BLVD STE B
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3660
Country	:	US
Telephone Number	:	323-721-9777
Fax Number	:	323-721-9787

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	HAREEM KIM
Credential	:
Telephone Number	:	310-791-0666

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	06/10/2026

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