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General NPI Number Information
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NPI Number | 1083100051
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Entity Type | Individual
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Provider Name | NOOR KASSEM
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Gender | Female
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 2071 RANCHO VALLEY DR STE 140
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City | POMONA
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State | CA
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Zip | 91766-7106
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Country | US
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Telephone | 909-374-1815
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Fax |
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Provider Business Mailing Address
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Address Line | 20648 SETON HILL DR
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City | WALNUT
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State | CA
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Zip | 91789-1021
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Country | US
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Telephone | 626-736-9799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102528
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License Number State | CA
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