Healthcare Provider Details

I. General information

NPI: 1063538882
Provider Name (Legal Business Name): TIANNA - THUY BICH DAO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 MCKEE RD SUITE 10
SAN JOSE CA
95116-1616
US

IV. Provider business mailing address

2207 CANYON CLIFF CT
SAN JOSE CA
95138-2455
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-9300
  • Fax: 408-926-7031
Mailing address:
  • Phone: 408-223-7298
  • Fax: 408-926-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: