Healthcare Provider Details

I. General information

NPI: 1821611971
Provider Name (Legal Business Name): BRADLEY Y TSUTSUI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 05/24/2020
Certification Date: 05/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5595 WINFIELD BLVD STE 102
SAN JOSE CA
95123-1220
US

IV. Provider business mailing address

5595 WINFIELD BLVD STE 102
SAN JOSE CA
95123-1220
US

V. Phone/Fax

Practice location:
  • Phone: 408-224-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY Y TSUTSUI
Title or Position: AUTHORIZED OFFICIAL
Credential: DDS
Phone: 559-287-0012