MEDICARE: MAITHAO T DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	46049	CA

General Provider Information

NPI Number	:	1225232705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAITHAO T DO

Provider Business Mailing Address
First Line	:	2319 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90040-1201
Country	:	US
Telephone Number	:	323-266-2120
Fax Number	:	323-266-7297

Provider Business Practice Location Address
First Line	:	2319 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90040-1201
Country	:	US
Telephone Number	:	323-266-2120
Fax Number	:	323-266-7297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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Directions to “ MAITHAO T DO ” Practice Location

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