1184395493 NPI number — KOHAN AND TSAI PROFESSIONAL DENTAL CORPORATION OF FONTANA

Table of content: (NPI 1518284702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184395493 NPI number — KOHAN AND TSAI PROFESSIONAL DENTAL CORPORATION OF FONTANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOHAN AND TSAI PROFESSIONAL DENTAL CORPORATION OF FONTANA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184395493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9190 SIERRA AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92335-8613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-356-4200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9190 SIERRA AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92335-8613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-356-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TSAI
Authorized Official First Name:
COLLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
415-794-4279

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com