Healthcare Provider Details

I. General information

NPI: 1093296972
Provider Name (Legal Business Name): JOSE ZEPEDA MEJIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 E IMPERIAL HWY
LYNWOOD CA
90262-2655
US

IV. Provider business mailing address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-7999
  • Fax:
Mailing address:
  • Phone: 562-867-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: