Provider Demographics
NPI:1285887059
Name:TCHON, SAMUEL (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:TCHON
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 TORRANCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4812
Mailing Address - Country:US
Mailing Address - Phone:310-792-7775
Mailing Address - Fax:
Practice Address - Street 1:3661 TORRANCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4812
Practice Address - Country:US
Practice Address - Phone:310-792-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery