Healthcare Provider Details

I. General information

NPI: 1407249204
Provider Name (Legal Business Name): 4D MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 VALLEY BLVD
ROSEMEAD CA
91770-1900
US

IV. Provider business mailing address

16562 REDWOOD CIR
FOUNTAIN VALLEY CA
92708-2320
US

V. Phone/Fax

Practice location:
  • Phone: 626-288-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. VIVIAN PHAM
Title or Position: MANAGER
Credential:
Phone: 714-590-2210