=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790065761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOO, HSIAO, & TSAI, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2011
-----------------------------------------------------
Last Update Date | 08/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 W 6TH ST #102
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-424-6200
-----------------------------------------------------
Fax | 562-424-9807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93122
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90809-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-424-6200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MATTHEW TSAI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 562-981-5002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 41564
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------