Individual
NINO HERALD CHAN GABUYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.D.A
Contact information
Practice address
21229 HAWTHORNE BLVD, TORRANCE, CA 90503-5501
(310) 792-5600
Mailing address
30711 GANADO DR, RANCHO PALOS VERDES, CA 90275-6279
(562) 726-5553
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
65717
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65717
RDA LICENCES
CA
Enumeration date
01/20/2009
Last updated
01/20/2009
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