=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114114147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENNIE CHEUNG, DMD MD AND VICTOR HO DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 10/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6240 W MANCHESTER AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-670-0220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6240 W MANCHESTER AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-670-0220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PARTNER
-----------------------------------------------------
Name | DR. VICTOR HO
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 310-670-0220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 41419
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------