Provider Demographics
NPI:1306008594
Name:TAM-JOHNSTON, JENNIFER YAH-LEA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:YAH-LEA
Last Name:TAM-JOHNSTON
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 1:644 CARIBBEAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3419
Mailing Address - Country:US
Mailing Address - Phone:917-334-2272
Mailing Address - Fax:
Practice Address - Street 1:644 CARIBBEAN WAY
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3419
Practice Address - Country:US
Practice Address - Phone:917-334-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0554431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice