1700328895 NPI number — TSAI & SNOWDEN PROFESSIONAL DENTAL CORPORATION

Table of content: (NPI 1700328895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700328895 NPI number — TSAI & SNOWDEN PROFESSIONAL DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TSAI & SNOWDEN PROFESSIONAL DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700328895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 W BEVERLY BLVD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-724-3800
Provider Business Mailing Address Fax Number:
323-722-4892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8247 WHITTIER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICO RIVERA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90660-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-692-1600
Provider Business Practice Location Address Fax Number:
323-722-4892
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TSAI
Authorized Official First Name:
COLLIN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
323-724-3800

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  58983 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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