Healthcare Provider Details

I. General information

NPI: 1770320376
Provider Name (Legal Business Name): OCEAN DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 ARTESIA PL
BELLFLOWER CA
90706-6757
US

IV. Provider business mailing address

9951 ARTESIA PL
BELLFLOWER CA
90706-6757
US

V. Phone/Fax

Practice location:
  • Phone: 562-866-6914
  • Fax:
Mailing address:
  • Phone: 562-866-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WONJOON LEE
Title or Position: DOCTOR
Credential: DDS
Phone: 562-278-2788