MEDICARE: MR. XIAOPANG CAI DENTIST

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	46756	CA

General Provider Information

NPI Number	:	1558351502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. XIAOPANG CAI DENTIST

Provider Business Mailing Address
First Line	:	733 NEW HIGH ST
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90012
Country	:	US
Telephone Number	:	213-680-2808
Fax Number	:	626-960-6992

Provider Business Practice Location Address
First Line	:	733 NEW HIGH
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90012
Country	:	US
Telephone Number	:	213-680-2808
Fax Number	:	626-960-6992

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/14/2007

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