Healthcare Provider Details

I. General information

NPI: 1700089364
Provider Name (Legal Business Name): JERRY TZOU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S ATLANTIC BLVD #308
MONTEREY PARK CA
91754-4756
US

IV. Provider business mailing address

809 S ATLANTIC BLVD #308
MONTEREY PARK CA
91754-4756
US

V. Phone/Fax

Practice location:
  • Phone: 626-282-5577
  • Fax: 626-282-5696
Mailing address:
  • Phone: 626-282-5577
  • Fax: 626-282-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: