Healthcare Provider Details

I. General information

NPI: 1285287995
Provider Name (Legal Business Name): HA TRAN TSAI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 EAST 4TH STREET
ONTARIO CA
91764
US

IV. Provider business mailing address

1361 EAST 4TH STREET
ONTARIO CA
91764
US

V. Phone/Fax

Practice location:
  • Phone: 415-794-4279
  • Fax:
Mailing address:
  • Phone: 415-794-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: COLLIN TSAI
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 415-794-4279