| Lea Bangsil Dmd Inc | |
|
548 W La Habra Blvd La Habra CA 90631-5308 | |
| (562) 690-5261 | |
| Not Available |
| Full Name | Lea Bangsil Dmd Inc |
|---|---|
| Speciality | Dentist |
| Location | 548 W La Habra Blvd, La Habra, California |
| Authorized Official Name and Position | Lea Bangsil (PRESIDENT) |
| Authorized Official Contact | 5626905261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lea Bangsil Dmd Inc 548 W La Habra Blvd La Habra CA 90631-5308 Ph: (562) 690-5261 | Lea Bangsil Dmd Inc 548 W La Habra Blvd La Habra CA 90631-5308 Ph: (562) 690-5261 |
| NPI Number | 1073562823 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 02/06/2015 |
| Medicare PECOS PAC ID | 3476870437 |
|---|---|
| Medicare Enrollment ID | O20150331002914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073562823 | NPI | - | NPPES |
| B40532-01 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | B40532 (California) | Primary |
| Provider Name | Lea Bangsil |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1861662603 PECOS PAC ID: 4385961341 Enrollment ID: I20150331002921 |
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