Individual
SOKBUNNTHA YAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.H.A.P
Contact information
Practice address
5810 FIDLER AVE, LAKEWOOD, CA 90712-1251
(562) 235-6403
Mailing address
5810 FIDLER AVE, LAKEWOOD, CA 90712-1251
(562) 235-6403
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
30940
CA
124Q00000X
Dental Hygienist
Primary
804
CA
Other
Enumeration date
11/06/2020
Last updated
01/21/2021
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