Provider Demographics
NPI:1164633764
Name:TOHAN, VIJAY (DDS)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:TOHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 CASS AVE
Mailing Address - Street 2:APT # 326
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1288
Mailing Address - Country:US
Mailing Address - Phone:734-675-1520
Mailing Address - Fax:734-675-2118
Practice Address - Street 1:22150 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2271
Practice Address - Country:US
Practice Address - Phone:734-675-1520
Practice Address - Fax:734-675-2118
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBT7439400OtherDEA