Healthcare Provider Details

I. General information

NPI: 1932157914
Provider Name (Legal Business Name): VIVIAN ONG SZETO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: VIVIAN L ONG DDS

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9663 TIERRA GRANDE ST SUITE 105
SAN DIEGO CA
92126-4568
US

IV. Provider business mailing address

10445 SUMMERWOOD CT
SAN DIEGO CA
92131-2331
US

V. Phone/Fax

Practice location:
  • Phone: 858-586-1500
  • Fax: 858-586-1965
Mailing address:
  • Phone: 858-566-0796
  • Fax: 858-566-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number25435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: