Organization Name: | DAVIDSKANGDDSINC |
NPI Number: | 1265626667 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID SONG KANG (OWNER) |
Mailing Address: | 14610 Hawthorne Blvd Lawndale |
State: | CA US |
Postal Code: | 902601521 |
Phone Number: | 3106764746 |
Fax Number: | 3106760944 |
NPI Enumeration Date: | 08/29/2007 |
NPI Last Update Date: | 01/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |