Provider Demographics
NPI:1730218140
Name:TI, ELAINE C
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:C
Last Name:TI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CHING-MEI
Other - Middle Name:
Other - Last Name:TI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1556 VIA ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-4119
Mailing Address - Country:US
Mailing Address - Phone:858-349-3628
Mailing Address - Fax:
Practice Address - Street 1:8221 ROCHESTER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0720
Practice Address - Country:US
Practice Address - Phone:909-989-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice