Provider Demographics
NPI:1053482414
Name:TSAI, MENGYU (DDS)
Entity Type:Individual
Prefix:
First Name:MENGYU
Middle Name:
Last Name:TSAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1465
Mailing Address - Country:US
Mailing Address - Phone:716-316-0605
Mailing Address - Fax:847-933-9463
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:SUITE 6E
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2230
Practice Address - Country:US
Practice Address - Phone:847-433-0320
Practice Address - Fax:847-433-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice