=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518977008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HEALTH TRUSR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2085 HAMILTON AVE SUITE 150
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-6117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-559-9385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2085 HAMILTON AVE SUITE 150
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-6117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-559-9385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTAL CLINIC DIRECTOR
-----------------------------------------------------
Name | DR. MICHAEL TAI
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 408-879-8423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 9149301
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 9149302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------