Healthcare Provider Details

I. General information

NPI: 1073699963
Provider Name (Legal Business Name): STACEY M WOO DDS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 TORRANCE BLVD STE 102
TORRANCE CA
90503-5805
US

IV. Provider business mailing address

17853 SANTIAGO BLVD # 107-133
VILLA PARK CA
92861-4113
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-1000
  • Fax:
Mailing address:
  • Phone: 530-428-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number54599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: