Individual
LAURA VY VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
3932 WILSHIRE BLVD STE 200, LOS ANGELES, CA 90010-3307
(213) 386-3336
Mailing address
969 HILGARD AVE APT 1201, LOS ANGELES, CA 90024-3002
(714) 272-2797
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DDS101147
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992892616
—
CA
Enumeration date
01/29/2016
Last updated
11/09/2021
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