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General NPI Number Information
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NPI Number | 1235621871
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Entity Type | Organization
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Legal Business Name | UNION DENTAL GROUP ANAHEIM INC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 434 S EUCLID ST # 100
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City | ANAHEIM
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State | CA
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Zip | 92802-1247
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Country | US
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Telephone | 714-533-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 434 S EUCLID ST # 100
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City | ANAHEIM
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State | CA
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Zip | 92802-1247
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BOUNG KIM
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Credential | D.D.S.
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Telephone | 714-533-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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