Healthcare Provider Details

I. General information

NPI: 1881870871
Provider Name (Legal Business Name): VIVIAN MAUNG DDS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8731 1/2 LA TIJERA BLVD
LOS ANGELES CA
90045-3906
US

IV. Provider business mailing address

8731 1/2 LA TIJERA BLVD
LOS ANGELES CA
90045-3906
US

V. Phone/Fax

Practice location:
  • Phone: 310-984-1638
  • Fax:
Mailing address:
  • Phone: 310-984-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number2880612
License Number StateCA

VIII. Authorized Official

Name: VIVIAN MAUNG
Title or Position: CEO
Credential: DDS, MS
Phone: 310-984-1638