MEDICARE: ELIZABETH L HOANG DMD & TED CHAN DMD, INC

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	44153	CA

General Provider Information

NPI Number	:	1518465715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH L HOANG DMD & TED CHAN DMD, INC

Provider Business Mailing Address
First Line	:	816 W WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2837
Country	:	US
Telephone Number	:	562-595-7077
Fax Number	:	562-490-4727

Provider Business Practice Location Address
First Line	:	816 W WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2837
Country	:	US
Telephone Number	:	562-595-7077
Fax Number	:	562-490-4727

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. TED CHAN
Credential	:	DMD
Telephone Number	:	714-539-7070

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	11/27/2023

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