Healthcare Provider Details

I. General information

NPI: 1407615016
Provider Name (Legal Business Name): STEPHANIE TSANG DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 FOREST AVE STE 2
SAN JOSE CA
95128-4812
US

IV. Provider business mailing address

16115 GREENWOOD LN
MONTE SERENO CA
95030-3012
US

V. Phone/Fax

Practice location:
  • Phone: 408-298-3433
  • Fax: 408-298-6304
Mailing address:
  • Phone: 408-656-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number106792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: