MEDICARE: MONGLAN HO D.D.S., 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	42661	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B42661-01	OTHER	CA	DELTA HEALTHY FAMILY
2	G92093-01	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1811098064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONGLAN HO D.D.S., INC.

Provider Business Mailing Address
First Line	:	16027 BROOKHURST ST
Second Line	:	SUITE J
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1551
Country	:	US
Telephone Number	:	714-839-2211
Fax Number	:	714-531-3685

Provider Business Practice Location Address
First Line	:	16027 BROOKHURST ST
Second Line	:	SUITE J
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1551
Country	:	US
Telephone Number	:	714-839-2211
Fax Number	:	714-531-3685

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MONGLAN HO
Credential	:	D.D.S.
Telephone Number	:	714-839-2211

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/22/2020

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