Provider Demographics
NPI:1437904935
Name:MORI, TIFFANY AKIE MINGWAI (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AKIE MINGWAI
Last Name:MORI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 SAMARITAN CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4001
Mailing Address - Country:US
Mailing Address - Phone:408-523-3300
Mailing Address - Fax:408-523-3096
Practice Address - Street 1:2506 SAMARITAN CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4001
Practice Address - Country:US
Practice Address - Phone:408-523-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant