Healthcare Provider Details

I. General information

NPI: 1356588990
Provider Name (Legal Business Name): XAVER BONDOC PANGILINAN RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 E GAGE AVE SUITE A
LOS ANGELES CA
90001-1771
US

IV. Provider business mailing address

16056 LANCET DR
WHITTIER CA
90603-2597
US

V. Phone/Fax

Practice location:
  • Phone: 323-983-4000
  • Fax: 323-983-4007
Mailing address:
  • Phone: 310-951-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number30965
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number70539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: