Basic Information
| Provider Information | |||||||||
| NPI: | 1083100051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASSEM | ||||||||
| FirstName: | NOOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20648 SETON HILL DR | ||||||||
| Address2: | |||||||||
| City: | WALNUT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917891021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267369799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2071 RANCHO VALLEY DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917667106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093741815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2018 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 102528 | CA | Y | Dental Providers | Dentist |
No ID Information.