MEDICARE: DR. ALAN JAYSON TENGONCIANG D.M.D

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	1223E0200X	Endodontics	61480	CA

General Provider Information

NPI Number	:	1851541031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN JAYSON TENGONCIANG D.M.D

Provider Business Mailing Address
First Line	:	3737 MORAGA AVE STE B313
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5481
Country	:	US
Telephone Number	:	858-270-2760
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE STE B313
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5481
Country	:	US
Telephone Number	:	858-270-2760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	11/19/2021

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