=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770034241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINH TSAI DDS, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2016
-----------------------------------------------------
Last Update Date | 10/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1285 CARLSBAD VILLAGE DR
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92008-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-730-3456
-----------------------------------------------------
Fax | 760-730-3513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1285 CARLSBAD VILLAGE DR
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92008-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-730-3456
-----------------------------------------------------
Fax | 760-730-3513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JAMES H TSAI
-----------------------------------------------------
Credential | RDH
-----------------------------------------------------
Telephone | 626-379-6694
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 51149
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------