Healthcare Provider Details

I. General information

NPI: 1629403522
Provider Name (Legal Business Name): CONAN JAMES TENG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 PACIFIC AVE
LONG BEACH CA
90806-3051
US

IV. Provider business mailing address

2360 PACIFIC AVE
LONG BEACH CA
90806-3051
US

V. Phone/Fax

Practice location:
  • Phone: 210-529-6556
  • Fax:
Mailing address:
  • Phone: 210-529-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101258
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: