MEDICARE: DR. SHAO TONG HUO D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	58403	CA

General Provider Information

NPI Number	:	1558591115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAO TONG HUO D.D.S

Provider Business Mailing Address
First Line	:	1724 LANDAU PL
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-3762
Country	:	US
Telephone Number	:	626-400-7036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 LANDAU PL
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-3762
Country	:	US
Telephone Number	:	626-400-7036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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