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Organization
LYDIA KOERNIANINGSIH DDS A PROF CORP
Active
Organization
LYDIA KOERNIANINGSIH DDS A PROF CORP
Active
Other names
LDJ Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA KOERNIANINGSIH (DENTIST / OWNER)
(714) 558-4895
Entity
Organization
Contact information
Practice address
1125 E 17TH ST STE W234, SANTA ANA, CA 92701-2228
(714) 558-4895
(714) 558-4896
Mailing address
1125 E 17TH ST STE W234, SANTA ANA, CA 92701-2228
(714) 558-4895
(714) 558-4896
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
48488
CA
Other
Enumeration date
03/06/2013
Last updated
01/24/2020
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