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:
Health care specialties
| Specialty | Code | License # | 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 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114083193 | NPPES |
| California | MEDICAID | D40950 |
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