Healthcare Provider Details

I. General information

NPI: 1366287492
Provider Name (Legal Business Name): TIFFANY HSIAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11549 SOUTH ST
CERRITOS CA
90703-6627
US

IV. Provider business mailing address

30120 VIA VICTORIA
RANCHO PALOS VERDES CA
90275-4438
US

V. Phone/Fax

Practice location:
  • Phone: 562-278-1609
  • Fax:
Mailing address:
  • Phone: 310-863-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: