Individual
MR. JOSE DANIEL DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12121 WILSHIRE BLVD, LOS ANGELES, CA 90025-1123
(310) 820-9933
Mailing address
5816 LEMP AVE, NORTH HOLLYWOOD, CA 91601-1023
(818) 310-7779
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
74403
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74403
DENTAL BOARD
CA
Enumeration date
01/14/2010
Last updated
01/14/2010
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