Healthcare Provider Details

I. General information

NPI: 1033765870
Provider Name (Legal Business Name): JESMINE BOGHAWALA DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13017 ARTESIA BLVD SUITE D120
CERRITOS CA
90703-5365
US

IV. Provider business mailing address

10929 SOUTH ST STE 110B
CERRITOS CA
90703-5365
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-6626
  • Fax:
Mailing address:
  • Phone: 562-860-6626
  • Fax: 562-860-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. JESMINE BOGHAWALA
Title or Position: DENTIST
Credential: DDS
Phone: 562-860-6626