Basic Information
| Provider Information | |||||||||
| NPI: | 1821306929 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TSAI, HSIAO & LOO DENTAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSAL CARE DENTAL GROUP | ||||||||
| 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: | 1000 VENICE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137488810 | ||||||||
| FaxNumber: | 2137488813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2010 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | TSAI | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5629815002 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 41564 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.