Individual
MS. KELLY UNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9050 WHITTIER BLVD, PICO RIVERA, CA 90660-2410
(562) 731-0470
Mailing address
15605 FACILIDAD ST, HACIENDA HEIGHTS, CA 91745-5205
(626) 474-7590
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA93516
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A5919410
—
CA
05
—
RDA93516
—
CA
Enumeration date
08/04/2020
Last updated
08/04/2020
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