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Organization

UCLA VENICE CLINICAL

Active
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Organization

UCLA VENICE CLINICAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN YAMAMANTO D.D.S. (CLENAL DIRECTOR)
(310) 392-4103
Entity
Organization

Contact information

Practice address
323 LINCOLN BLVD, VENICE, CA 90291-2842
(310) 392-4103
(310) 392-8513
Mailing address
323 LINCOLN BLVD, VENICE, CA 90291-2842
(310) 392-4103
(310) 392-8513

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D40407
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
UO1004
CA
Enumeration date
01/23/2007
Last updated
08/22/2020
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