Healthcare Provider Details

I. General information

NPI: 1740791060
Provider Name (Legal Business Name): SEOK HWAN SON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E ORANGETHORPE AVE
ANAHEIM CA
92801-1206
US

IV. Provider business mailing address

40 E ORANGETHORPE AVE
ANAHEIM CA
92801-1206
US

V. Phone/Fax

Practice location:
  • Phone: 213-453-4368
  • Fax: 714-281-8200
Mailing address:
  • Phone: 213-453-4368
  • Fax: 714-281-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number52471
License Number StateCA

VIII. Authorized Official

Name: SEOK HWAN SON
Title or Position: CEO
Credential:
Phone: 714-870-6611