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NPI Code Detail

MEDICARE: FUN DENTAL 4 KIDS 5

MEDICARE: FUN DENTAL 4 KIDS 5
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1578189098
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUN DENTAL 4 KIDS 5
Provider Business Mailing Address
First Line : 3738 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-6046
Country : US
Telephone Number : 323-487-5768
Fax Number :
Provider Business Practice Location Address
First Line : 3738 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-6046
Country : US
Telephone Number : 323-487-5768
Fax Number : 323-487-5810
Authorized Official
Title or Position : OWNER DOCTOR
Name : DR. JOHN YOO
Credential : DDS
Telephone Number : 310-619-5880
Provider Enumeration Date : 06/20/2020
Last Update Date : 07/27/2023

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Directions to “FUN DENTAL 4 KIDS 5 ” Practice Location

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