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General NPI Number Information
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NPI Number | 1376708610
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Entity Type | Organization
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Legal Business Name | STAR WHITE DENTAL CLINIC
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 2105 SAN JOAQUIN HILLS RD
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6507
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Country | US
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Telephone | 949-721-7130
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Fax | 949-721-1709
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Provider Business Mailing Address
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Address Line | 2105 SAN JOAQUIN HILLS RD.
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-721-7130
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Fax | 949-721-1709
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BONG KOOG NOH
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Credential | D.D.S
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Telephone | 949-721-1730
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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 | 54697
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License Number State | CA
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