Provider Demographics
NPI:1811098064
Name:MONGLAN HO D.D.S., INC.
Entity type:Organization
Organization Name:MONGLAN HO D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONGLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-839-2211
Mailing Address - Street 1:16027 BROOKHURST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1551
Mailing Address - Country:US
Mailing Address - Phone:714-839-2211
Mailing Address - Fax:714-531-3685
Practice Address - Street 1:16027 BROOKHURST ST
Practice Address - Street 2:SUITE J
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1551
Practice Address - Country:US
Practice Address - Phone:714-839-2211
Practice Address - Fax:714-531-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42661-01OtherDELTA HEALTHY FAMILY
CAG92093-01OtherDENTICAL