Organization
REGENTS OF THE UNIVERSITY OF UCLA MAXILLOFACIAL PROSTHODONTICS
Active
Other names
UCLA Maxillofacial Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC C SUNG DDS (DIRECTOR)
(310) 206-6407
Entity
Organization
Contact information
Practice address
10833 LE CONTE AVE RM AO-156A CHS, BOX 951668, LOS ANGELES, CA 90095-3075
(310) 825-6510
(310) 206-4201
Mailing address
10833 LE CONTE AVE RM AO-156A, BOX 951668, LOS ANGELES, CA 90095-3075
(310) 825-6510
(310) 206-4201
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
38370
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G91297
—
CA
Enumeration date
01/30/2007
Last updated
12/12/2014
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