Provider Demographics
NPI:1710293022
Name:TSAP, KATHERINE MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:TSAP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:POKRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1240 S WESTLAKE BLVD
Mailing Address - Street 2:#127
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1929
Mailing Address - Country:US
Mailing Address - Phone:805-230-2293
Mailing Address - Fax:805-230-2296
Practice Address - Street 1:1240 S WESTLAKE BLVD
Practice Address - Street 2:#127
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:805-230-2293
Practice Address - Fax:805-230-2296
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59513122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist