Healthcare Provider Details

I. General information

NPI: 1679271985
Provider Name (Legal Business Name): BYUN, HA, AND PATEL DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 N TUSTIN ST
ORANGE CA
92865-4605
US

IV. Provider business mailing address

12292 NANTUCKET PL
SEAL BEACH CA
90740-2772
US

V. Phone/Fax

Practice location:
  • Phone: 714-637-8662
  • Fax:
Mailing address:
  • Phone: 562-967-0126
  • Fax:

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. JETAN PATEL
Title or Position: CORP SECRETARY
Credential: DDS
Phone: 562-967-0126