Ucla Venice Clinical
Dentist, General Practice in Venice, CA. Organization (NPI-2).
NPI number1932253184
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1932253184
- Entity type
- Organization (NPI-2)
- Legal business name
- Ucla Venice Clinical
- Organization subpart
- No
- Enumeration date
- Jan 23, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | D40407 | CA | Yes |
Practice location
323 Lincoln BlvdVenice, CA 90291-2842
Phone 310-392-4103 · Fax 310-392-8513
Mailing address
323 Lincoln BlvdVenice, CA 90291-2842
Phone 310-392-4103 · Fax 310-392-8513
Authorized official
John Yamamanto
Clenal Director
3103924103
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