Provider Demographics
NPI:1730369620
Name:GARY C. TSAI, DENTAL CORP.
Entity type:Organization
Organization Name:GARY C. TSAI, DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-284-6706
Mailing Address - Street 1:825 W LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1072
Mailing Address - Country:US
Mailing Address - Phone:626-284-6706
Mailing Address - Fax:626-284-3328
Practice Address - Street 1:825 W LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1072
Practice Address - Country:US
Practice Address - Phone:626-284-6706
Practice Address - Fax:626-284-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA503741Medicare PIN