Provider Demographics
NPI:1043365059
Name:CHAO, DOROTHY WENYI (DDS)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:WENYI
Last Name:CHAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 KATELLA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-4901
Mailing Address - Country:US
Mailing Address - Phone:714-209-7702
Mailing Address - Fax:714-209-7658
Practice Address - Street 1:7757 KATELLA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-4901
Practice Address - Country:US
Practice Address - Phone:714-209-7702
Practice Address - Fax:714-209-7658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8194022OtherUNITED CONCORDIA HMO
CA900232OtherUNITED CONCORDIA PPO
CAG94098-01OtherDENTI-CAL PROVIDER ID