Provider Demographics
NPI:1447779871
Name:CALIFORNIA WAVE DENTAL CENTER
Entity type:Organization
Organization Name:CALIFORNIA WAVE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:JUN
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-988-9959
Mailing Address - Street 1:16444 PARAMOUNT BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5453
Mailing Address - Country:US
Mailing Address - Phone:562-633-6580
Mailing Address - Fax:
Practice Address - Street 1:16444 PARAMOUNT BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5453
Practice Address - Country:US
Practice Address - Phone:562-633-6580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty