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General NPI Number Information
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NPI Number | 1245308923
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Entity Type | Organization
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Legal Business Name | CENTRAL DENTAL GROUP
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2111 S ATLANTIC BLVD
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6801
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Country | US
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Telephone | 323-261-9999
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Fax | 323-261-9998
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Provider Business Mailing Address
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Address Line | 2111 S ATLANTIC BLVD.
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City | MONTEREY PARK
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State | CA
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Zip | 91754
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Country | US
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Telephone | 323-261-9999
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Fax | 323-261-9998
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Authorized Official
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Title or Position | OWNER
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Name | KY LIEN DO
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Credential |
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Telephone | 323-261-9999
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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 | 41399
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License Number State | CA
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