Healthcare Provider Details

I. General information

NPI: 1285756981
Provider Name (Legal Business Name): CHANG HSIANG HUO DENTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W LAS TUNAS DR SUITE D
ARCADIA CA
91007
US

IV. Provider business mailing address

17055 ROYAL VIEW DR
HACIENDA HEIGHTS CA
91745
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-6566
  • Fax: 626-821-9477
Mailing address:
  • Phone: 626-964-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number49335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: