Provider Demographics
NPI:1275969404
Name:KWAN, TIFFANY JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:JANE
Last Name:KWAN
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 1:725 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6242
Mailing Address - Country:US
Mailing Address - Phone:916-505-8115
Mailing Address - Fax:
Practice Address - Street 1:1634 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8337
Practice Address - Country:US
Practice Address - Phone:916-505-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29499122300000X
CA62871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist