Provider Demographics
NPI:1255331294
Name:TAY, EMERALD S (MD)
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:S
Last Name:TAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 E VALLEY BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-4600
Mailing Address - Country:US
Mailing Address - Phone:626-307-8636
Mailing Address - Fax:626-307-8705
Practice Address - Street 1:222 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3521
Practice Address - Country:US
Practice Address - Phone:626-307-8636
Practice Address - Fax:626-307-8705
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A722230Medicaid
CAH31304Medicare UPIN
CA00A722230Medicaid