Provider Demographics
NPI:1285114561
Name:OCHIAI, ALYSSA ALYSSON
Entity type:Individual
Prefix:
First Name:ALYSSA ALYSSON
Middle Name:
Last Name:OCHIAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 TIVERTON AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3001
Mailing Address - Country:US
Mailing Address - Phone:415-993-1550
Mailing Address - Fax:
Practice Address - Street 1:3465 TORRANCE BLVD STE G
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5804
Practice Address - Country:US
Practice Address - Phone:310-543-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist