Provider Demographics
NPI:1467172817
Name:THEO MYINT HAN DDS INC
Entity Type:Organization
Organization Name:THEO MYINT HAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEO MYINT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-231-1869
Mailing Address - Street 1:891 E. ARROW HWY. SUITE B
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5868
Mailing Address - Country:US
Mailing Address - Phone:626-332-4788
Mailing Address - Fax:626-332-5388
Practice Address - Street 1:891 E. ARROW HWY. SUITE B
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5868
Practice Address - Country:US
Practice Address - Phone:626-332-4788
Practice Address - Fax:626-332-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental