Healthcare Provider Details

I. General information

NPI: 1992189229
Provider Name (Legal Business Name): DR. LOIDA PARUNGAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 SANTA MONICA BLVD STE 403
LOS ANGELES CA
90029-1260
US

IV. Provider business mailing address

5300 SANTA MONICA BLVD STE 403
LOS ANGELES CA
90029-1260
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-5696
  • Fax: 323-461-5268
Mailing address:
  • Phone: 323-461-5696
  • Fax: 323-461-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: