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Organization
STATE FAMILY DENTAL
Active
Organization
STATE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORAN JEONG DDS (PRESIDENT)
(323) 567-2995
Entity
Organization
Contact information
Practice address
8928 STATE ST, SOUTH GATE, CA 90280-2926
(323) 567-2995
(323) 567-2930
Mailing address
516 N MARIPOSA AVE, LOS ANGELES, CA 90004-2806
(646) 236-0717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
57737
CA
Other
Enumeration date
02/09/2015
Last updated
02/09/2015
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