Healthcare Provider Details

I. General information

NPI: 1104735281
Provider Name (Legal Business Name): BARDI PAK CHEN DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 SAN MARINO AVE
SAN MARINO CA
91108-2027
US

IV. Provider business mailing address

1437 SAN MARINO AVE
SAN MARINO CA
91108-2027
US

V. Phone/Fax

Practice location:
  • Phone: 626-878-3636
  • Fax:
Mailing address:
  • Phone: 626-878-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: HA REEM KIM
Title or Position: REGIONAL MANAGER
Credential:
Phone: 626-878-3636