Healthcare Provider Details

I. General information

NPI: 1801016944
Provider Name (Legal Business Name): LAN BICH DAO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E HUNTINGTON DR STE 201
MONROVIA CA
91016-3612
US

IV. Provider business mailing address

1211 S RAMONA ST
SAN GABRIEL CA
91776-3223
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-8300
  • Fax: 626-359-8311
Mailing address:
  • Phone: 310-699-0775
  • Fax: 626-359-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: