Provider Demographics
NPI:1376023457
Name:CHOW, BREANNA GABRIELLE PO-LING (DDS)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:GABRIELLE PO-LING
Last Name:CHOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BREANNA
Other - Middle Name:GABRIELLE PO-LING
Other - Last Name:CHOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 S BEACH BLVD STE 206A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1881
Mailing Address - Country:US
Mailing Address - Phone:714-995-5168
Mailing Address - Fax:
Practice Address - Street 1:408 S BEACH BLVD STE 206A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1881
Practice Address - Country:US
Practice Address - Phone:714-995-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist