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General NPI Number Information
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NPI Number | 1487043246
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Entity Type | Organization
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Legal Business Name | TRI CITY DENTAL CARE OF CERRITOS
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 18822 PALO VERDE AVE
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City | CERRITOS
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State | CA
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Zip | 90703-9242
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Country | US
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Telephone | 562-920-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 18822 PALO VERDE AVE
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City | CERRITOS
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State | CA
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Zip | 90703-9242
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Country | US
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Telephone | 562-920-1731
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW W CHIN
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Credential | DDS
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Telephone | 562-920-1731
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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 | 43525
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License Number State | CA
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