Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 34243 | CA |
NPI | 1043201726 |
---|---|
Provider Name | Dr. Vincent John Tso |
First Address | South Pasadena, CA 91030-2527 |
Second Address | South Pasadena, CA 91030-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 31/03/2008 |