MEDICARE: DR. HYO SANG SON 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	1223G0001X	General Practice Dentistry	50534	CA

General Provider Information

NPI Number	:	1609900703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYO SANG SON D.D.S

Provider Business Mailing Address
First Line	:	3461 SANTA CARLOTTA ST
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-1159
Country	:	US
Telephone Number	:	213-248-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7208 PACIFIC BLVD STE 200
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5770
Country	:	US
Telephone Number	:	323-582-2200
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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