Healthcare Provider Details

I. General information

NPI: 1992867519
Provider Name (Legal Business Name): INNE S OEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 S HACIENDA BLVD. SUITE210
HACIENDA HTS CA
91745-4610
US

IV. Provider business mailing address

1837 14 VALLECITO DR
HACIENDA HTS CA
91745-3345
US

V. Phone/Fax

Practice location:
  • Phone: 626-330-6599
  • Fax: 626-333-9360
Mailing address:
  • Phone: 626-330-6599
  • Fax: 626-333-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberB28213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: