Healthcare Provider Details

I. General information

NPI: 1710808019
Provider Name (Legal Business Name): TONY GUAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E JULIAN ST
SAN JOSE CA
95112-4007
US

IV. Provider business mailing address

1659 30TH AVE
SAN FRANCISCO CA
94122-3207
US

V. Phone/Fax

Practice location:
  • Phone: 408-457-7101
  • Fax:
Mailing address:
  • Phone: 415-318-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: