Provider Demographics
NPI:1912172867
Name:MEDBERY, TREVOR NG (DDS)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:NG
Last Name:MEDBERY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2916
Mailing Address - Country:US
Mailing Address - Phone:310-860-0102
Mailing Address - Fax:310-276-1314
Practice Address - Street 1:9665 WILSHIRE BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2340
Practice Address - Country:US
Practice Address - Phone:310-860-0102
Practice Address - Fax:310-276-1314
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28042OtherCAL. LIC. NO. 28042