Healthcare Provider Details

I. General information

NPI: 1164556395
Provider Name (Legal Business Name): SOPHIA SY-HANN XIANG UPDIKE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA SY-HANN XIANG DDS

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E YALE LOOP STE 202
IRVINE CA
92604-4697
US

IV. Provider business mailing address

13528 CHARLWOOD CIR
CERRITOS CA
90703-6322
US

V. Phone/Fax

Practice location:
  • Phone: 949-870-9713
  • Fax:
Mailing address:
  • Phone: 310-709-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number53113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: