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General NPI Number Information
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NPI Number | 1285771378
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF UCLA MAXILLOFACIAL PROSTHODONTICS
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE RM AO-156A CHS BOX 951668
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-825-6510
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Fax | 310-206-4201
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE RM AO-156A BOX 951668
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-825-6510
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Fax | 310-206-4201
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ERIC C SUNG
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Credential | DDS
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Telephone | 310-206-6407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 38370
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License Number State | CA
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