Provider Demographics
NPI:1619028305
Name:HUBERT J DORION DDS
Entity Type:Organization
Organization Name:HUBERT J DORION DDS
Other - Org Name:HUBERT J DORION DDS A PROFESSIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DORION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-678-4779
Mailing Address - Street 1:645 EAST AERICK STREET
Mailing Address - Street 2:#3
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4881
Mailing Address - Country:US
Mailing Address - Phone:323-678-4779
Mailing Address - Fax:310-677-6786
Practice Address - Street 1:645 EAST AERICK STREET
Practice Address - Street 2:#3
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4881
Practice Address - Country:US
Practice Address - Phone:323-678-4779
Practice Address - Fax:310-677-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22538OtherUNITED CONCORDIA
CAB1503301Medicaid