MEDICARE: DR. VIVIEN LAO D.D.S.

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	1223P0221X	Pediatric Dentistry	60380	CA

General Provider Information

NPI Number	:	1942580923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIEN LAO D.D.S.

Provider Business Mailing Address
First Line	:	3771 SHINING STAR DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-6227
Country	:	US
Telephone Number	:	310-467-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	2226 OTAY LAKES RD STE AANDB
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1000
Country	:	US
Telephone Number	:	619-336-8478
Fax Number	:

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

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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