MEDICARE: OU AND CHAN DENTAL INC

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
1	1223G0001X	General Practice Dentistry	37890	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710068317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OU AND CHAN DENTAL INC

Provider Business Mailing Address
First Line	:	5480 PHILADELPHIA ST
Second Line	:	STE D
City	:	CHINO
State	:	CA
Zip	:	91710-2486
Country	:	US
Telephone Number	:	909-464-2399
Fax Number	:	909-464-2398

Provider Business Practice Location Address
First Line	:	5480 PHILADELPHIA ST
Second Line	:	STE D
City	:	CHINO
State	:	CA
Zip	:	91710-2486
Country	:	US
Telephone Number	:	909-464-2399
Fax Number	:	909-464-2398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SU HWEI OU
Credential	:	DDS
Telephone Number	:	909-464-2399

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/20/2016

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Directions to “OU AND CHAN DENTAL INC ” Practice Location

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