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General NPI Number Information
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NPI Number | 1356810758
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Entity Type | Organization
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Legal Business Name | JASON H. TA, DMD, INC.
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 16709 HAWTHORNE BLVD.
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City | LAWNDALE
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State | CA
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Zip | 90260
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Country | US
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Telephone | 310-592-5558
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Fax | 310-542-4309
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Provider Business Mailing Address
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Address Line | 16709 HAWTHORNE BLVD.
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City | LAWNDALE
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State | CA
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Zip | 90260
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Country | US
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Telephone | 310-592-5558
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Fax | 310-542-4309
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. JASON H. TA
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Credential | D.M.D.
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Telephone | 310-542-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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