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General NPI Number Information
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NPI Number | 1710068317
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Entity Type | Organization
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Legal Business Name | OU AND CHAN DENTAL INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 5480 PHILADELPHIA ST STE D
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City | CHINO
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State | CA
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Zip | 91710-2486
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Country | US
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Telephone | 909-464-2399
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Fax | 909-464-2398
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Provider Business Mailing Address
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Address Line | 5480 PHILADELPHIA ST STE D
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City | CHINO
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State | CA
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Zip | 91710-2486
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Country | US
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Telephone | 909-464-2399
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Fax | 909-464-2398
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SU HWEI OU
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Credential | DDS
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Telephone | 909-464-2399
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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 | 37890
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License Number State | CA
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