=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770577017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH BAY CHILDRENS HEALTH CENTER ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 04/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14722 HAWTHORNE BLVD SUITE A
-----------------------------------------------------
City | LAWNDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90260-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-973-5437
-----------------------------------------------------
Fax | 310-316-4411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 CAMINO REAL
-----------------------------------------------------
City | REDONDO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90277-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-316-1212
-----------------------------------------------------
Fax | 310-316-4411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTAL DIRECTOR
-----------------------------------------------------
Name | DR. MEGHA SATA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 310-973-5437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 960000038
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------