Provider Demographics
NPI:1407997968
Name:TZENG, MELINDA LEE (DDS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEE
Last Name:TZENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2392 COWPER ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-4114
Mailing Address - Country:US
Mailing Address - Phone:650-321-0566
Mailing Address - Fax:
Practice Address - Street 1:15215 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1810
Practice Address - Country:US
Practice Address - Phone:510-969-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist