MEDICARE: HAN, JANG, SON & SUH, DENTAL GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223G0001X	General Practice Dentistry
3	1223P0221X	Pediatric Dentistry
4	1223P0700X	Prosthodontics
5	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
6	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1275781932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAN, JANG, SON & SUH, DENTAL GROUP, PC

Provider Business Mailing Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	780
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-380-7900
Fax Number	:	213-382-3454

Provider Business Practice Location Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	780
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-380-7900
Fax Number	:	213-382-3454

Authorized Official
Title or Position	:	CORPORATE SEC./ EXEC. DIRECTOR
Name	:	DR. LEE JAY HARRIS
Credential	:	DDS
Telephone Number	:	213-380-7900

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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Directions to “HAN, JANG, SON & SUH, DENTAL GROUP, PC ” Practice Location

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