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General NPI Number Information
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NPI Number | 1821766783
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Entity Type | Individual
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Provider Name | PHOEBE TAI
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Gender | Female
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 1673 BRANHAM LN
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City | SAN JOSE
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State | CA
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Zip | 95118-5211
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Country | US
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Telephone | 408-269-6861
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Fax |
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Provider Business Mailing Address
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Address Line | 10539 JOHN WAY
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City | CUPERTINO
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State | CA
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Zip | 95014-4345
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Country | US
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Telephone | 408-823-6041
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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 | 34944
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License Number State | CA
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