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General NPI Number Information
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NPI Number | 1417574385
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Entity Type | Organization
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Legal Business Name | JACK M TSAI DMD INC
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 24901 SANTA CLARA ST # B2
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City | HAYWARD
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State | CA
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Zip | 94544-2147
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Country | US
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Telephone | 732-771-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 24901 SANTA CLARA ST STE 2
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City | HAYWARD
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State | CA
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Zip | 94544-2147
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Country | US
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Telephone | 510-887-6835
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Fax | 510-887-2872
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Authorized Official
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Title or Position | CEO
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Name | DR. JACK TSAI
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Credential | DMD
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Telephone | 732-771-6127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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