Healthcare Provider Details

I. General information

NPI: 1326424136
Provider Name (Legal Business Name): GRACE NAM HUGHES D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 E SPRING ST
LONG BEACH CA
90815-1424
US

IV. Provider business mailing address

4764 FIR AVE
SEAL BEACH CA
90740-3011
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-9439
  • Fax:
Mailing address:
  • Phone: 832-305-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number64539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: