Healthcare Provider Details

I. General information

NPI: 1386760411
Provider Name (Legal Business Name): TSAI, HSIAO & LOO DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 PACIFIC AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

P.O BOX 93122
LONG BEACH CA
90809
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-0731
  • Fax: 562-595-6452
Mailing address:
  • Phone: 562-424-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number48503
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41564
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA WILLIAMSON
Title or Position: SUPERVISOR
Credential:
Phone: 562-424-6200