Healthcare Provider Details

I. General information

NPI: 1679993091
Provider Name (Legal Business Name): MATTHEW C TSAI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 BARRANCA PKWY #204
IRVINE CA
92604-8645
US

IV. Provider business mailing address

4980 BARRANCA PKWY #204
IRVINE CA
92604-8645
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-8547
  • Fax:
Mailing address:
  • Phone: 949-552-8547
  • Fax: 949-552-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number41564
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW TSAI
Title or Position: OWNER
Credential: DDS
Phone: 949-552-8547