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General NPI Number Information
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NPI Number | 1710408737
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Entity Type | Individual
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Provider Name | TIFFANIE TIAN YU OD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 06/29/2017
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Provider Practice Location Address
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Address Line | 6180 STATE FARM DR
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2135
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Country | US
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Telephone | 707-584-7294
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MORNING STAR DR
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City | SAN JOSE
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State | CA
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Zip | 95131-3754
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Country | US
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Telephone | 248-982-4589
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33748
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License Number State | CA
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