Provider Demographics
NPI:1740791060
Name:SEOK HWAN SON DDS INC
Entity Type:Organization
Organization Name:SEOK HWAN SON DDS INC
Other - Org Name:ANAHEIM DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEOK
Authorized Official - Middle Name:HWAN
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-870-6611
Mailing Address - Street 1:40 E ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1206
Mailing Address - Country:US
Mailing Address - Phone:213-453-4368
Mailing Address - Fax:714-281-8200
Practice Address - Street 1:40 E ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1206
Practice Address - Country:US
Practice Address - Phone:213-453-4368
Practice Address - Fax:714-281-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366654832OtherINDIVIDUAL NPI