Provider Demographics
NPI:1386911550
Name:TUAN, LARRY CHI-TSENG (LARRY TUAN)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:CHI-TSENG
Last Name:TUAN
Suffix:
Gender:M
Credentials:LARRY TUAN
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:CHI-TSENG
Other - Last Name:TUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1418 SANTA TERESA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8550
Practice Address - Country:US
Practice Address - Phone:626-445-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392211223P0300X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentistGroup - Single Specialty