Provider Demographics
NPI:1083703557
Name:TSENG, JESSY I (DDS)
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:I
Last Name:TSENG
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 1:235 N SAN MATEO DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2621
Mailing Address - Country:US
Mailing Address - Phone:650-340-0228
Mailing Address - Fax:650-340-9111
Practice Address - Street 1:235 N SAN MATEO DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2621
Practice Address - Country:US
Practice Address - Phone:650-340-0228
Practice Address - Fax:650-340-9111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics