Healthcare Provider Details

I. General information

NPI: 1407972219
Provider Name (Legal Business Name): TSAI, HSIAO & LOO DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 N. PALO VERDE AVE #208
LONG BEACH CA
90809-4132
US

IV. Provider business mailing address

P.O BOX 93122
LONG BEACH CA
90809
US

V. Phone/Fax

Practice location:
  • Phone: 562-429-1642
  • Fax: 562-429-1643
Mailing address:
  • Phone: 800-635-6668
  • Fax: 562-424-9807

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: 562-981-5044