=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952911323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRANDBURG, CHENG, GARCIA AND HUYNH DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2020
-----------------------------------------------------
Last Update Date | 12/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11687 NATIONAL BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-426-1234
-----------------------------------------------------
Fax | 424-426-1235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11687 NATIONAL BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-426-1234
-----------------------------------------------------
Fax | 424-426-1235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DENTIST
-----------------------------------------------------
Name | CHRISTOPHER STRANDBURG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 916-276-9588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------