Jirawan Srivivatanakul D.D.S., INC.
Clinic/Center, Dental in Cerritos, CA. Organization (NPI-2).
NPI number1265624399
StatusActive
Last updated in NPPESAug 13, 2007
Details
- NPI
- 1265624399
- Entity type
- Organization (NPI-2)
- Legal business name
- Jirawan Srivivatanakul D.D.S., INC.
- Organization subpart
- No
- Enumeration date
- Aug 13, 2007
- Last updated
- Aug 13, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | 48771 | CA | Yes |
Practice location
17360 Norwalk BlvdCerritos, CA 90703-2748
Phone 562-402-8899
Mailing address
17360 Norwalk BlvdCerritos, CA 90703-2748
Phone 562-402-8899
Authorized official
Jirawan Srivivatanakul
Dentist
5624028899
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