Healthcare Provider Details

I. General information

NPI: 1780454199
Provider Name (Legal Business Name): SEUNG C SON DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 S WESTERN AVE STE 210
LOS ANGELES CA
90006-2376
US

IV. Provider business mailing address

1144 S WESTERN AVE STE 210
LOS ANGELES CA
90006-2376
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-4111
  • Fax:
Mailing address:
  • Phone: 714-870-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEUNG CHEON SON
Title or Position: CEO
Credential: DDS
Phone: 562-665-0738