Organization
CALIFORNIA DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY KU D.D.S. (OWNER)
(626) 288-2000
Entity
Organization
Contact information
Practice address
1448 S SAN GABRIEL BLVD, SAN GABRIEL, CA 91776-3656
(626) 288-2000
Mailing address
1448 S SAN GABRIEL BLVD, SAN GABRIEL, CA 91776-3656
(626) 288-2000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
65148
CA
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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