Sudirgo, Ridwan
Sudirgo, Ridwan is an sole proprietor health care provider with primary practice located at 2218 W Beverly Blvd , Montebello CA 90640-2302. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Sudirgo, Ridwan can be contacted via phone (323) 721-6221.Contact Information
Primary practice address
2218 W Beverly Blvd
Montebello CA 90640-2302
Phone: (323) 721-6221
Fax: (323) 721-8641
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 36010 | California |
Profile Details
| NPI number | 1811037443 |
|---|---|
| LBN Legal business name | Sudirgo, Ridwan |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 6th, 2007 |
| Last updated | Jul 9th, 2007 - about 18 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 | 1811037443 | NPPES |
| California | MEDICAID | B 36010-01 |
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