GLENDALE SURGICAL ASSOCIATES NPI 1205090610

NPI Information

  • NPI: 1205090610
  • Provider Name: GLENDALE SURGICAL ASSOCIATES
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Doing Business As: PACIFIC COAST OMS
  • Address: 1146 N BRAND BLVD
    GLENDALE, CA
    ZIP 91202
  • Phone: (818) 241-4217

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NPI Details

GLENDALE SURGICAL ASSOCIATES is an oral and maxillofacial surgery dentist in Glendale, CA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. GLENDALE SURGICAL ASSOCIATES NPI is 1205090610. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Pacific Coast Oms.

The provider's business location address is:

1146 N BRAND BLVD
GLENDALE, CA
ZIP 91202-504
Phone: (818) 241-4217

The provider's authorized official is Nam Cho .
The authorized official title is Partner/owner and has the following contact phone number (206) 356-0449.

The enumeration date for this NPI number is 7/15/2008 and was last updated on 4/20/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryOMS94CALIFORNIANo
21223S0112XDentistOral and Maxillofacial SurgeryOMS71CALIFORNIANo
31223S0112XDentistOral and Maxillofacial Surgery37945CALIFORNIAYes

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This page was last updated on: 11/21/2025

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