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General NPI Number Information
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NPI Number | 1831558352
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Entity Type | Organization
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Legal Business Name | TITUS TANG DDS INC
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 59B SERRAMONTE CTR
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City | DALY CITY
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State | CA
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Zip | 94015-2345
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Country | US
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Telephone | 650-755-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 59B SERRAMONTE CTR
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City | DALY CITY
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State | CA
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Zip | 94015-2345
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Country | US
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Telephone | 650-755-1222
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TITUS TANG
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Credential | D.D.S
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Telephone | 650-755-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63855
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 60361
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 52475
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License Number State | CA
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