Healthcare Provider Details

I. General information

NPI: 1407997968
Provider Name (Legal Business Name): MELINDA LEE TZENG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA LEE DDS

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 WASHINGTON AVE
SAN LEANDRO CA
94579-1810
US

IV. Provider business mailing address

2392 COWPER ST
PALO ALTO CA
94301-4114
US

V. Phone/Fax

Practice location:
  • Phone: 510-969-7050
  • Fax:
Mailing address:
  • Phone: 650-321-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: