| Ucla Grad Endo Clinic | |
|
10833 Le Conte Ave Suite 30-125 Chs Los Angeles CA 90095-1668 | |
| (310) 825-4348 | |
| (310) 206-5030 |
| Full Name | Ucla Grad Endo Clinic |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 10833 Le Conte Ave, Los Angeles, California |
| Authorized Official Name and Position | Mo Kwan Kang (DIRECTOR) |
| Authorized Official Contact | 3108254348 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ucla Grad Endo Clinic 10833 Le Conte Ave Suite 30-125 Chs Los Angeles CA 90095-1668 Ph: (310) 825-4348 | Ucla Grad Endo Clinic 10833 Le Conte Ave Suite 30-125 Chs Los Angeles CA 90095-1668 Ph: (310) 825-4348 |
| NPI Number | 1063630267 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063630267 | NPI | - | NPPES |
| G01005-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | D51343 (California) | Primary |
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