Provider Demographics
NPI:1710068317
Name:OU AND CHAN DENTAL INC
Entity Type:Organization
Organization Name:OU AND CHAN DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SU HWEI
Authorized Official - Middle Name:
Authorized Official - Last Name:OU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-464-2399
Mailing Address - Street 1:5480 PHILADELPHIA ST
Mailing Address - Street 2:STE D
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2486
Mailing Address - Country:US
Mailing Address - Phone:909-464-2399
Mailing Address - Fax:909-464-2398
Practice Address - Street 1:5480 PHILADELPHIA ST
Practice Address - Street 2:STE D
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2486
Practice Address - Country:US
Practice Address - Phone:909-464-2399
Practice Address - Fax:909-464-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37890Medicaid