Healthcare Provider Details

I. General information

NPI: 1437299666
Provider Name (Legal Business Name): MICHAEL H TAI DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CRAVEN ST
SAN DIEGO CA
92136-5596
US

IV. Provider business mailing address

600 FRONT ST #403
SAN DIEGO CA
92101-6730
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8240
  • Fax:
Mailing address:
  • Phone: 619-235-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number038293-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: