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General NPI Number Information
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NPI Number | 1750052965
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Entity Type | Organization
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Legal Business Name | LI & NGUYEN DENTAL CORP
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 2707 E VALLEY BLVD STE 301
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City | WEST COVINA
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State | CA
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Zip | 91792-3198
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Country | US
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Telephone | 909-908-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 S BREA CANYON RD STE 121
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3783
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Country | US
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Telephone | 909-869-1098
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JINGJING LI
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Credential |
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Telephone | 909-908-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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