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Organization
JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION
Active
Organization
JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION
Active
Other names
Thai Smile Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIRAVAT WANGWONGVIVAT D.D.S. (PRESIDENT)
(818) 765-8280
Entity
Organization
Contact information
Practice address
12724 SHERMAN WAY, NORTH HOLLYWOOD, CA 91605-5031
(818) 765-8280
(818) 765-8454
Mailing address
12724 SHERMAN WAY, NORTH HOLLYWOOD, CA 91605-5031
(818) 765-8280
(818) 765-8454
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B40201-01
MEDI-CAL I. D. NUMBER
CA
Enumeration date
10/18/2005
Last updated
08/22/2020
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