Healthcare Provider Details

I. General information

NPI: 1225701154
Provider Name (Legal Business Name): COLLIN TSAI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 CHICAGO AVE
RIVERSIDE CA
92507-5340
US

IV. Provider business mailing address

4028 CHICAGO AVE
RIVERSIDE CA
92507-5340
US

V. Phone/Fax

Practice location:
  • Phone: 951-328-1166
  • Fax:
Mailing address:
  • Phone: 951-328-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

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