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General NPI Number Information
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NPI Number | 1144883331
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Entity Type | Individual
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Provider Name | NATHANIEL TSAI
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Gender | Male
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 11272 MERRITT ST STE A
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City | CASTROVILLE
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State | CA
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Zip | 95012-3422
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Country | US
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Telephone | 831-633-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 8 BOWIE RD
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City | ROLLING HILLS
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State | CA
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Zip | 90274-5220
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Country | US
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Telephone | 310-739-3988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS104615
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License Number State | CA
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