Provider Demographics
NPI:1972755841
Name:OCEAN WEST DENTAL GROUP
Entity Type:Organization
Organization Name:OCEAN WEST DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHU-JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-375-5462
Mailing Address - Street 1:3903 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5796
Mailing Address - Country:US
Mailing Address - Phone:310-375-5462
Mailing Address - Fax:
Practice Address - Street 1:3903 PACIFIC COAST HWY
Practice Address - Street 2:SUITE D
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5796
Practice Address - Country:US
Practice Address - Phone:310-375-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty