Healthcare Provider Details

I. General information

NPI: 1710199195
Provider Name (Legal Business Name): YAO-LIN TANG D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S EL CAMINO REAL
SAN MATEO CA
94401-3810
US

IV. Provider business mailing address

100 S EL CAMINO REAL
SAN MATEO CA
94401-3810
US

V. Phone/Fax

Practice location:
  • Phone: 650-343-4040
  • Fax: 650-347-6322
Mailing address:
  • Phone: 650-343-4040
  • Fax: 650-347-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. YAO-LIN TANG
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 650-343-4040