Provider Demographics
NPI:1124188941
Name:SY, TESSIE TAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TESSIE
Middle Name:TAN
Last Name:SY
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 1:4565 NORTH PECK ROAD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732
Mailing Address - Country:US
Mailing Address - Phone:626-350-3295
Mailing Address - Fax:626-350-3371
Practice Address - Street 1:4565 N. PECK ROAD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732
Practice Address - Country:US
Practice Address - Phone:626-350-3295
Practice Address - Fax:626-350-3371
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice