Provider Demographics
NPI:1326117763
Name:TSURUDOME, TIFFANY LEUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LEUNG
Last Name:TSURUDOME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CHRISTINE
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:256 N SAN MATEO DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2624
Mailing Address - Country:US
Mailing Address - Phone:650-826-1205
Mailing Address - Fax:
Practice Address - Street 1:38 N SAN MATEO DR STE 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2824
Practice Address - Country:US
Practice Address - Phone:650-826-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice