Provider Demographics
NPI:1609363423
Name:EPROSYSTEM INC.
Entity type:Organization
Organization Name:EPROSYSTEM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-584-2802
Mailing Address - Street 1:3208 E LOS ANGELES AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6107
Mailing Address - Country:US
Mailing Address - Phone:805-584-2802
Mailing Address - Fax:805-584-1410
Practice Address - Street 1:3208 E LOS ANGELES AVE
Practice Address - Street 2:SUITE 33
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-584-2802
Practice Address - Fax:805-584-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS36589261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center