Basic Information
| Provider Information | |||||||||
| NPI: | 1467760561 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOO, HSIAO, & TSAI, A PROFESSIONAL CORPORATION | ||||||||
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| OtherOrganizationName: | CALIFORNIA DENTAL SPECIALTIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 93122 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908093122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624246200 | ||||||||
| FaxNumber: | 5629815074 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 E HILL ST | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907553612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624246200 | ||||||||
| FaxNumber: | 5629815074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2010 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | TSAI | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5629815002 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 45489 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Endodontics | 1223X0400X | 45269 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.