Im, Ted Tae Yul

Im, Ted Tae Yul is an individual health care provider with primary practice located at 23205 Sunnymead Blvd , Moreno Valley CA 92553-5246. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Im, Ted Tae Yul can be contacted via phone (951) 242-6242.

Contact Information

Primary practice address
23205 Sunnymead Blvd Moreno Valley CA 92553-5246
Phone: (951) 242-6242
Fax: (951) 242-4782
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 40950 California

Profile Details

NPI number 1114083193
LBN Legal business name Im, Ted Tae Yul
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2006
Last updated Sep 19th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114083193 NPPES
California MEDICAID D40950

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