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Organization
BENJAMIN COREY
Active
Organization
BENJAMIN COREY
Active
Other names
Benjamin Corey
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN FREDRIC COREY (OWNER)
(626) 755-0003
Entity
Organization
Contact information
Practice address
17120 RIDGE PARK DR, HACIENDA HEIGHTS, CA 91745
(626) 755-0003
Mailing address
65 PINE AVE # 360, LONG BEACH, CA 90802-4718
(626) 755-0003
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RW8585
CCBADC
CA
Enumeration date
10/09/2014
Last updated
03/16/2021
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