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NPI Code Detail

MEDICARE: LC MEDICAL & DENTAL CENTER

MEDICARE: LC MEDICAL & DENTAL CENTER
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
1207R00000XInternal Medicine PhysicianA61531CA
2122300000XDentist49290CA

General Provider Information

NPI Number : 1811140536
Entity Type Code : Organization
Provider Name (Legal Business Name) : LC MEDICAL & DENTAL CENTER
Provider Business Mailing Address
First Line : 5825 LINCOLN AVE
Second Line : SUITE H
City : BUENA PARK
State : CA
Zip : 90620-3463
Country : US
Telephone Number : 714-761-1736
Fax Number : 714-761-7179
Provider Business Practice Location Address
First Line : 5825 LINCOLN AVE
Second Line : SUITE H
City : BUENA PARK
State : CA
Zip : 90620-3463
Country : US
Telephone Number : 714-761-1736
Fax Number : 714-761-7179
Authorized Official
Title or Position : SECRETARY
Name : CHRISTINE CHIEM
Credential : DDS
Telephone Number : 714-761-1736
Provider Enumeration Date : 10/25/2008
Last Update Date : 10/25/2008

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Directions to “LC MEDICAL & DENTAL CENTER ” Practice Location

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