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General NPI Number Information
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NPI Number | 1982738639
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Entity Type | Organization
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Legal Business Name | UCLA SCHOOL OF DENTISTRY
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE #33-039 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-6672
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Fax | 310-794-7964
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE. CHS A3-034
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-5891
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Fax | 310-794-7964
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Authorized Official
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Title or Position | ASSOC. CLIN PROFESSOR
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Name | DR. DEUKWON JO
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Credential | DDS
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Telephone | 310-825-5891
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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 | D46182
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License Number State | CA
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