Provider Demographics
NPI:1861594608
Name:AU, TAK CHING (DMD)
Entity type:Individual
Prefix:
First Name:TAK CHING
Middle Name:
Last Name:AU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:BENSON
Other - Middle Name:
Other - Last Name:AU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4718 SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1322
Mailing Address - Country:US
Mailing Address - Phone:626-443-3433
Mailing Address - Fax:626-443-3498
Practice Address - Street 1:4718 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1322
Practice Address - Country:US
Practice Address - Phone:626-443-3433
Practice Address - Fax:626-443-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice