Provider Demographics
NPI:1619215175
Name:HANNAH SONG AND HELEN DO DENTAL CORPORATION
Entity Type:Organization
Organization Name:HANNAH SONG AND HELEN DO DENTAL CORPORATION
Other - Org Name:MY HOME DENTAL GROUP - BUENA PARK PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/ C.F.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:JIYOUNG
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-994-2121
Mailing Address - Street 1:5661 BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1969
Mailing Address - Country:US
Mailing Address - Phone:714-994-2121
Mailing Address - Fax:
Practice Address - Street 1:5661 BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1969
Practice Address - Country:US
Practice Address - Phone:714-994-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty