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NPI Code Detail

MEDICARE: FUN DENTAL 4 KIDS 3

MEDICARE: FUN DENTAL 4 KIDS 3
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 : 1649733015
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUN DENTAL 4 KIDS 3
Provider Business Mailing Address
First Line : 6383 ATLANTIC AVE
Second Line :
City : BELL
State : CA
Zip : 90201-1227
Country : US
Telephone Number : 310-619-5880
Fax Number :
Provider Business Practice Location Address
First Line : 2864 E FLORENCE AVE # 3
Second Line :
City : HUNTINGTON PARK
State : CA
Zip : 90255-5749
Country : US
Telephone Number : 310-619-5880
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : JOHN YOO
Credential : DDS
Telephone Number : 310-619-5880
Provider Enumeration Date : 04/11/2019
Last Update Date : 04/11/2019

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