Healthcare Provider Details

I. General information

NPI: 1962373233
Provider Name (Legal Business Name): JOHN CUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W REDLANDS BLVD STE F
LOMA LINDA CA
92373-8032
US

IV. Provider business mailing address

10751 COLOMA ST
LOMA LINDA CA
92354-2301
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-5100
  • Fax:
Mailing address:
  • Phone: 951-222-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: