Healthcare Provider Details

I. General information

NPI: 1255252847
Provider Name (Legal Business Name): HUNTINGTON PARK DENTAL IMPLANT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 SANTA FE AVE
HUNTINGTON PARK CA
90255-3808
US

IV. Provider business mailing address

6416 SANTA FE AVE
HUNTINGTON PARK CA
90255-3808
US

V. Phone/Fax

Practice location:
  • Phone: 323-749-6062
  • Fax: 323-749-6519
Mailing address:
  • Phone: 213-994-7111
  • Fax: 323-749-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEX LEE
Title or Position: PRESIDENT
Credential: DMD
Phone: 213-399-4711