San Gabriel Valley Oral and Facial Surgery

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

40257 Issued in CA

Legal business name

SAN GABRIEL VALLEY ORAL AND FACIAL SURGERY

Practice address

126 S Glendora Ave Ste 108
West Covina, CA 91790-3047

Phone

(626) 966-8518

Fax

(626) 967-0990

NPI assigned

Nov 6, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patty K Bogle

Title

Practice Administrator

Phone

(626) 966-8518

Specialties & licenses 1

Addresses

Other names 1

• Peter S. Lam DDS, INC. Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1679086243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 S GLENDORA AVE STE 108",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903047",
            "telephone_number": "626-966-8518",
            "fax_number": "626-967-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S GLENDORA AVE STE 108",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903047",
            "telephone_number": "626-966-8518",
            "fax_number": "626-967-0990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2453 Huntington Dr",
            "address_purpose": "LOCATION",
            "city": "San Marino",
            "state": "CA",
            "postal_code": "911082644",
            "country_code": "US",
            "telephone_number": "626-486-0700",
            "fax_number": "626-486-0706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN GABRIEL VALLEY ORAL AND FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-06",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "BOGLE",
        "authorized_official_first_name": "PATTY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "626-966-8518"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "40257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peter S. Lam DDS, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• San Gabriel Valley Consulting Pathologists Medical Group, Inc.
• San Gabriel Valley Diagnostic Center Medical Group
• San Gabriel Valley Imaging Partnership (Valley Imaging Partnership)
• San Gabriel Valley Neurological Medical Group
• San Gabriel Valley Oral & Facial Surgery
• San Gabriel Valley Perinatal Medical Group, Inc
• San Gabriel Valley Sleep Lab, LLC
• San Gabriel Valley Surgical Center LP
• San Gabriel Vip a California Limited Partnership (Valley Imaging Partnership)
• San Gabriel Vip, a California Limited Partnership (Valley Imaging Partnership)

• Dental Clinic/Center in West Covina, CA
• Providers in West Covina, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.