Organization · NPI-2

Central Dental Group

Dentist, General Practice · Monterey Park, CA

NPI number1245308923
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1245308923
Entity type
Organization (NPI-2)
Legal business name
Central Dental Group
Organization subpart
No
Enumeration date
Dec 1, 2006
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice41399CAYes

Practice location

2111 S Atlantic Blvd
Monterey Park, CA 91754-6801

Phone 323-261-9999 · Fax 323-261-9998

Mailing address

2111 S Atlantic Blvd.
Monterey Park, CA 91754

Phone 323-261-9999 · Fax 323-261-9998

Authorized official

Ky Lien DO
Owner
3232619999

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