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General NPI Number Information
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NPI Number | 1942580923
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Entity Type | Individual
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Provider Name | VIVIEN LAO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 2226 OTAY LAKES RD STE AANDB
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City | CHULA VISTA
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State | CA
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Zip | 91915-1000
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Country | US
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Telephone | 619-336-8478
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Fax |
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Provider Business Mailing Address
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Address Line | 3771 SHINING STAR DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-6227
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Country | US
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Telephone | 310-467-1391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 60380
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License Number State | CA
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