# REGENTS OF THE UNIVERSITY OF UCLA MAXILLOFACIAL PROSTHODONTICS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UCLA Maxillofacial Prosthetics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285771378
- **Authorized official:** DR. ERIC C SUNG DDS (DIRECTOR)
- **Authorized official phone:** (310) 206-6407

## Contact information

- **Practice address:** 10833 LE CONTE AVE RM AO-156A CHS, BOX 951668, LOS ANGELES, CA 90095-3075
- **Practice address phone:** (310) 825-6510
- **Practice address fax:** (310) 206-4201
- **Mailing address:** 10833 LE CONTE AVE RM AO-156A, BOX 951668, LOS ANGELES, CA 90095-3075
- **Mailing address phone:** (310) 825-6510
- **Mailing address fax:** (310) 206-4201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 38370 | CA | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 12/12/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | G91297 | — | CA |