Healthcare Provider Details

I. General information

NPI: 1164633764
Provider Name (Legal Business Name): VIJAY TOHAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22150 ALLEN RD
WOODHAVEN MI
48183-2271
US

IV. Provider business mailing address

4500 CASS AVE APT # 326
DETROIT MI
48201-1288
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-1520
  • Fax: 734-675-2118
Mailing address:
  • Phone: 734-675-1520
  • Fax: 734-675-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017403
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: