Healthcare Provider Details

I. General information

NPI: 1780986919
Provider Name (Legal Business Name): CYNTHIA KAY KHINE ZAW TERASHIMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA KAY KHINE ZAW TAN M.D.

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 01/10/2022
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1000
  • Fax: 707-651-3494
Mailing address:
  • Phone: 707-651-1000
  • Fax: 707-651-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA140221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: