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NPI Code Detail

MEDICARE: DR. SHIHO TAMAI THERIOT DDS

MEDICARE: DR. SHIHO TAMAI THERIOT DDS
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
11223G0001XGeneral Practice Dentistry5666LA
21223G0001XGeneral Practice DentistryDDS62082CA

General Provider Information

NPI Number : 1770609547
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHIHO TAMAI THERIOT DDS
Provider Business Mailing Address
First Line : 4753 ABARGO ST
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-4518
Country : US
Telephone Number : 504-481-4170
Fax Number :
Provider Business Practice Location Address
First Line : 5400 FOUNTAIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90029-1007
Country : US
Telephone Number : 323-461-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 10/05/2024

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