Provider Demographics
NPI:1518465715
Name:ELIZABETH L HOANG DMD & TED CHAN DMD, INC
Entity Type:Organization
Organization Name:ELIZABETH L HOANG DMD & TED CHAN DMD, INC
Other - Org Name:COASTAL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-539-7070
Mailing Address - Street 1:816 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2837
Mailing Address - Country:US
Mailing Address - Phone:562-595-7077
Mailing Address - Fax:562-490-4727
Practice Address - Street 1:816 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2837
Practice Address - Country:US
Practice Address - Phone:562-595-7077
Practice Address - Fax:562-490-4727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMEGA FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty