Healthcare Provider Details

I. General information

NPI: 1962033902
Provider Name (Legal Business Name): POMONA COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SULTANA AVE
ONTARIO CA
91764-3235
US

IV. Provider business mailing address

1450 E HOLT AVE
POMONA CA
91767-5822
US

V. Phone/Fax

Practice location:
  • Phone: 909-630-7927
  • Fax:
Mailing address:
  • Phone: 909-630-7927
  • Fax: 909-620-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID MICHAEL KADAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DDS
Phone: 909-630-7939