Provider Demographics
NPI:1922163310
Name:TO, SEAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:S
Last Name:TO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 S DIAMOND BAR BLVD UNIT 4462
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-5620
Mailing Address - Country:US
Mailing Address - Phone:909-988-0000
Mailing Address - Fax:909-988-1001
Practice Address - Street 1:5562 PHILADELPHIA ST STE 201
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2482
Practice Address - Country:US
Practice Address - Phone:909-988-1000
Practice Address - Fax:909-988-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH89543Medicare UPIN