MEDICARE: COLLIN TSAI DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1225701154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIN TSAI DDS INC

Provider Business Mailing Address
First Line	:	4028 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5340
Country	:	US
Telephone Number	:	951-328-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	4028 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5340
Country	:	US
Telephone Number	:	951-328-1166
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	COLLIN TSAI
Credential	:
Telephone Number	:	415-794-4279

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	09/14/2021

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