Provider Demographics
NPI:1417574385
Name:JACK M TSAI DMD INC
Entity Type:Organization
Organization Name:JACK M TSAI DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-771-6127
Mailing Address - Street 1:24901 SANTA CLARA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-2147
Mailing Address - Country:US
Mailing Address - Phone:510-887-6835
Mailing Address - Fax:510-887-2872
Practice Address - Street 1:24901 SANTA CLARA ST # B2
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2147
Practice Address - Country:US
Practice Address - Phone:732-771-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty