Healthcare Provider Details

I. General information

NPI: 1295031250
Provider Name (Legal Business Name): TSAI, HSIAO & LOO DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 E PALMDALE BLVD
PALMDALE CA
93550-4866
US

IV. Provider business mailing address

1680 E HILL ST
SIGNAL HILL CA
90755-3612
US

V. Phone/Fax

Practice location:
  • Phone: 866-427-0474
  • Fax:
Mailing address:
  • Phone: 562-424-6200
  • Fax: 562-981-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41564
License Number StateCA

VIII. Authorized Official

Name: MATTHEW TSAI
Title or Position: CEO
Credential: DDS
Phone: 949-331-7074