Provider Demographics
NPI:1083772909
Name:TAY, GEORGE KYAWMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KYAWMIN
Last Name:TAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:TAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4607 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1919
Mailing Address - Country:US
Mailing Address - Phone:323-227-9885
Mailing Address - Fax:323-227-9897
Practice Address - Street 1:4607 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1919
Practice Address - Country:US
Practice Address - Phone:323-227-9885
Practice Address - Fax:323-227-9897
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA143350OtherHEALTH NET
CA01406OtherWESTERN DENTAL
CA109235OtherDENTAL HEALTH SERVICE
CA796195OtherAETNA HMO
CA0011928OtherPACIFICARE
CA53033-1OtherDENTAL BENEFIT PROVIDER
CA679078OtherUNITED CONCORDIA
CA00002850OtherMANAGE DENTAL GUARD
CA000634OtherDELTACARE (PMI)
CAB45032-01Medicaid
CA030TOtherUNIVERSALCARE
CA796195OtherAETNA DMO
CA104262OtherSAFEGUARD HEALTHY FAMILY
CA25763OtherSAFEGUARD