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General NPI Number Information
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NPI Number | 1508584756
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Entity Type | Organization
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Legal Business Name | WHITTIER MODERN DENTISTRY DENTAL GROUP
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 11806 WHITTIER BLVD STE E
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City | WHITTIER
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State | CA
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Zip | 90601-4622
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Country | US
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Telephone | 562-513-1146
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Fax | 562-513-5142
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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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 | OWNER DOCTOR
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Name | CHRISTINA M KIM
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Credential | DMD
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Telephone | 562-513-1146
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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 |
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License Number State |
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