Healthcare Provider Details

I. General information

NPI: 1033278882
Provider Name (Legal Business Name): LUCY TSAI D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BERKELEY SQ
BERKELEY CA
94704-1206
US

IV. Provider business mailing address

2255 HEARST AVE APT #12
BERKELEY CA
94709-1853
US

V. Phone/Fax

Practice location:
  • Phone: 510-540-8400
  • Fax:
Mailing address:
  • Phone: 510-849-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: