Healthcare Provider Details

I. General information

NPI: 1750520854
Provider Name (Legal Business Name): DR RHA'S DENTAL OFFICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 SCOTT BLVD
SANTA CLARA CA
95050
US

IV. Provider business mailing address

1240 SCOTT BLVD
SANTA CLARA CA
95050-4517
US

V. Phone/Fax

Practice location:
  • Phone: 408-246-0300
  • Fax: 408-246-0518
Mailing address:
  • Phone: 408-246-0300
  • Fax: 408-246-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number47166
License Number StateCA

VIII. Authorized Official

Name: KYUNG RHAN RHA
Title or Position: PRESIDENT
Credential:
Phone: 408-246-0300