Provider Demographics
NPI:1679262331
Name:HUNG, HSIAO JO
Entity Type:Individual
Prefix:
First Name:HSIAO JO
Middle Name:
Last Name:HUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10568 GATEWAY PROMENADE UNIT 501
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3641
Mailing Address - Country:US
Mailing Address - Phone:646-510-7809
Mailing Address - Fax:
Practice Address - Street 1:11450 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3230
Practice Address - Country:US
Practice Address - Phone:866-410-5719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist