Provider Demographics
NPI:1114911179
Name:TSAI, JACK CHING-KUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:CHING-KUAN
Last Name:TSAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 S CITRUS ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3400
Mailing Address - Country:US
Mailing Address - Phone:626-367-3077
Mailing Address - Fax:
Practice Address - Street 1:8300 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2651
Practice Address - Country:US
Practice Address - Phone:626-573-3616
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice