# E.WENDY HERNANDEZ, DDS, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Heavenly Kids Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053866517
- **Authorized official:** DR. ELSA WENDY HERNANDEZ DDS (OWNER/PRESIDENT)
- **Authorized official phone:** (619) 251-1312

## Contact information

- **Practice address:** 1210 N LONG BEACH BLVD STE 196, COMPTON, CA 90221-1685
- **Practice address phone:** (424) 785-8708
- **Practice address fax:** (424) 785-8718
- **Mailing address:** 12920 RUNWAY RD UNIT 310, PLAYA VISTA, CA 90094-2313
- **Mailing address phone:** (424) 785-8708
- **Mailing address fax:** (424) 785-8718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 56388 | CA | Yes |

## Other

- **Enumeration date:** 08/24/2016
- **Last updated:** 08/24/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1437580644 | ELSA W HERNANDEZ, DDS, INC | CA |
| 01 | — | 1497938401 | DENTIST | CA |