Healthcare Provider Details

I. General information

NPI: 1568152775
Provider Name (Legal Business Name): EMMIE HO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 HOLT BLVD STE A2
MONTCLAIR CA
91763-4837
US

IV. Provider business mailing address

11140 MARION AVE
MONTCLAIR CA
91763-6525
US

V. Phone/Fax

Practice location:
  • Phone: 909-625-6545
  • Fax:
Mailing address:
  • Phone: 301-401-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: