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Provider Information for 1700901527

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. PHIL JAE RA D.D.S.

Gender: MALE

Individual NPI: 1700901527

Calendar   Last Updated:  2015-05-21
  Certification Date: 

Details

Name Value
NPI 1700901527
Enumeration Date 2007-03-20
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 11201 SIERRA AVE SUITE 1F
FONTANA, CA 92337-7581
United States

Phone: 909-355-3299 | Fax: 909-355-3944
View Map External Link
Primary Practice Address 11201 SIERRA AVE SUITE 1F
FONTANA, CA 92337-7581
United States

Phone: 909-355-3299 | Fax: 909-355-3944
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 47551