Healthcare Provider Details

I. General information

NPI: 1972528958
Provider Name (Legal Business Name): MICHELLE TO, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S MEDNIK AVE
EAST LOS ANGELES CA
90022-1606
US

IV. Provider business mailing address

151 S MEDNIK AVE
EAST LOS ANGELES CA
90022-1606
US

V. Phone/Fax

Practice location:
  • Phone: 323-263-3303
  • Fax:
Mailing address:
  • Phone: 323-263-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number46337
License Number StateCA

VIII. Authorized Official

Name: DR. MICHELLE PUI HAN TO
Title or Position: OWNER
Credential: DDS
Phone: 323-263-3303