Provider Demographics
NPI:1356588990
Name:PANGILINAN, XAVER BONDOC (RDH)
Entity type:Individual
Prefix:MR
First Name:XAVER
Middle Name:BONDOC
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16056 LANCET DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2597
Mailing Address - Country:US
Mailing Address - Phone:310-951-6193
Mailing Address - Fax:
Practice Address - Street 1:1423 E GAGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1771
Practice Address - Country:US
Practice Address - Phone:323-983-4000
Practice Address - Fax:323-983-4007
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30965124Q00000X
CA70539126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA70539OtherRDA LICENSE
CA30965OtherDHCC