Provider Demographics
NPI:1376685214
Name:TAI-EDMONDS, JACQUELINE SINGYEE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SINGYEE
Last Name:TAI-EDMONDS
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 1:211 QUARRY RD
Mailing Address - Street 2:STE 301
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1416
Mailing Address - Country:US
Mailing Address - Phone:650-723-6028
Mailing Address - Fax:
Practice Address - Street 1:211 QUARRY RD
Practice Address - Street 2:STE 301
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1416
Practice Address - Country:US
Practice Address - Phone:650-723-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A917360Medicaid
CAI41760Medicare UPIN
CA00A917360Medicaid