Provider Demographics
NPI:1629410550
Name:TAMBUNAN, RACHEL CHRISTINE (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CHRISTINE
Last Name:TAMBUNAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKES DR STE 405
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2927
Mailing Address - Country:US
Mailing Address - Phone:626-489-3488
Mailing Address - Fax:626-489-3489
Practice Address - Street 1:1000 LAKES DR STE 405
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2927
Practice Address - Country:US
Practice Address - Phone:626-489-3488
Practice Address - Fax:626-489-3489
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist