Provider Demographics
NPI:1770689952
Name:CHI, TONY T (DMD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:T
Last Name:CHI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5121
Mailing Address - Country:US
Mailing Address - Phone:562-436-8294
Mailing Address - Fax:562-437-2195
Practice Address - Street 1:123 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5121
Practice Address - Country:US
Practice Address - Phone:562-436-8294
Practice Address - Fax:562-437-2195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU55042Medicare UPIN
CAD37202Medicare ID - Type Unspecified