Provider Demographics
NPI:1518977008
Name:THE HEALTH TRUSR
Entity Type:Organization
Organization Name:THE HEALTH TRUSR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-879-8423
Mailing Address - Street 1:2085 HAMILTON AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-6117
Mailing Address - Country:US
Mailing Address - Phone:408-559-9385
Mailing Address - Fax:
Practice Address - Street 1:2085 HAMILTON AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-6117
Practice Address - Country:US
Practice Address - Phone:408-559-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91493021223P0221X
CA91493011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91493-02OtherDENTI-CAL
CAG91493-01OtherDENTI-CAL