Healthcare Provider Details

I. General information

NPI: 1083427843
Provider Name (Legal Business Name): AMY C. HAO D.D.S., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 LA MART DR STE 102
RIVERSIDE CA
92507-5991
US

IV. Provider business mailing address

5005 LA MART DR STE 102
RIVERSIDE CA
92507-5991
US

V. Phone/Fax

Practice location:
  • Phone: 951-786-9141
  • Fax:
Mailing address:
  • Phone: 951-786-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE COX
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-786-9141