Healthcare Provider Details

I. General information

NPI: 1093259004
Provider Name (Legal Business Name): IRVING CHAO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S MAIN ST
SALINAS CA
93901-2205
US

IV. Provider business mailing address

1211 S MAIN ST
SALINAS CA
93901-2205
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-1535
  • Fax: 831-424-0953
Mailing address:
  • Phone: 831-424-1535
  • Fax: 831-424-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58661
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW DALEY
Title or Position: COO
Credential:
Phone: 831-540-4323