Healthcare Provider Details

I. General information

NPI: 1104388875
Provider Name (Legal Business Name): TINA YAH TSENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 TULLY RD STE 304
SAN JOSE CA
95122-3055
US

IV. Provider business mailing address

1340 TULLY RD STE 304
SAN JOSE CA
95122-3055
US

V. Phone/Fax

Practice location:
  • Phone: 408-271-3900
  • Fax:
Mailing address:
  • Phone: 408-271-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAPCC17189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI37161222
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC17189
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAPCC17189
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberAPCC17189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: