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General NPI Number Information
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NPI Number | 1528295672
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Entity Type | Organization
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Legal Business Name | DOE MYUNG NA, D.D.S. A DENTAL CORP
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 7604 RESEDA BLVD
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City | RESEDA
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State | CA
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Zip | 91335-2822
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Country | US
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Telephone | 818-343-3916
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Fax | 818-343-9640
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Provider Business Mailing Address
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Address Line | 7604 RESEDA BLVD
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City | RESEDA
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State | CA
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Zip | 91335-2822
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Country | US
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Telephone | 818-343-3916
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Fax | 818-343-9640
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Authorized Official
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Title or Position | CEO
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Name | DR. DOE MYUNG NA
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Credential | D.D.S.
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Telephone | 818-343-3916
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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 | 29391
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License Number State | CA
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