Healthcare Provider Details

I. General information

NPI: 1669512695
Provider Name (Legal Business Name): JAVIER A MEJIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 PRIMROSE CIRCLE
SEAL BEACH CA
90740
US

IV. Provider business mailing address

3591 PRIMROSE CIRCLE
SEAL BEACH CA
90740-3128
US

V. Phone/Fax

Practice location:
  • Phone: 310-499-3111
  • Fax:
Mailing address:
  • Phone: 310-499-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: