| Ted T. Im, DDS, Inc. | |
|
23205 Sunnymead Blvd Moreno Valley CA 92553-5246 | |
| (951) 242-6242 | |
| (951) 242-4782 |
| Full Name | Ted T. Im, DDS, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 23205 Sunnymead Blvd, Moreno Valley, California |
| Authorized Official Name and Position | Ted Im (PRESIDENT) |
| Authorized Official Contact | 9512426242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ted T. Im, DDS, Inc. 23205 Sunnymead Blvd Moreno Valley CA 92553-5246 Ph: (951) 242-6242 | Ted T. Im, DDS, Inc. 23205 Sunnymead Blvd Moreno Valley CA 92553-5246 Ph: (951) 242-6242 |
| NPI Number | 1770821423 |
|---|---|
| Provider Enumeration Date | 01/30/2013 |
| Last Update Date | 09/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770821423 | NPI | - | NPPES |
| D40950 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 40950 (California) | Primary |
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